Artist Mark said...
I'm not sure exactly what you are saying ,but the reality is that there are significant SE's in doing different treatments and by adding more and more types. In your "perfect" scenario of all things being equal, of course I'd take the treatment with the lower HR. I don't think I said I wouldn't. But as you stated all things are rarely equal, SE's did come into play in my decision of treatment, guided most by my Dr's recommendation. I am the one that pushed for the chemo as I wanted to give it the most aggressive approach that was available to me. I knew the SE's that I could be facing and was willing to take that chance, especially since surgery and BT were not an option.
I guess the one thing that this thread has done, (and the discussion that has come out of it) is to point out how difficult it is to make those treatment decisions.( especially after just being told that you have grade 5 PC).
I try not to get into the surgery/RT debate just for that reason. Each of us need to do our due diligence and make the decision that is best for them.
It's quite obvious that in reality, none of us know exactly how this PC journey will effect us down the road. For me my battle at this time is trying to keep looking forward and try to live life the best I can with this "NEW" normal. That sounds cliché and it is,but it really is the best I can do at this time.
I guess I am having trouble getting my thoughts across. My bad.
" I don't think I said I wouldn't.". I don't think you did either. I certainly did not mean to imply that you did. Did I? If I did, my apologies! I have just been trying to clarify the point I have been struggling to make.
That point has to do with studies in general, and "statistical significance" specifically. That is all I'm talking about
. And please remember, I don't yet have a dog in this specific study's results, as I have not yet had any form of RT or ADT.
And the point is- let me try again maybe I can do better- studies like this often announce(very common) in what I refer to as the headline: "No difference found" or "no benefit" of X vs Y. But in fact, when one digs into the details of the study, there is in fact a benefit. But there is no statistical significance
in the benefit that is found. Or, even worse, there is a statistical significance
found in one of the benefits or pros and cons, but it is not found in the PRIMARY outcome they were looking at.
An example would be more than one RCT vitamin D studies that did not show a significant advantage to giving children a very large dose of Vitamin D compared to simply a large dose, when it comes to colds, which was the primary outcome, and thus the headline is "No advantage". But when you dig into BOTH studies, both showed a 50% improvement(which I think also had statistical significance) when it comes to getting the flu, which is a good bit more important to know about
than simple colds. But you are never going to know about
that advantage unless you dig into the details of the study.
Somewhat similar in this study from the OP. The main conclusion is
"CONCLUSIONS: WPRT was not associated with improved PCSS or DMFS in patients with GG 5 PCa who received either EBRT or EBRT+BT.......................we did not find a difference in their survival from prostate cancer or in their survival without metastatic disease". But when you read the details, it turns out there was indeed a difference in all 3 areas looked at for one group, and in 2 outcomes looked at in the other group, with some negative outcomes reduced by HALF. With some of the outcomes showing an HR of .8 to .5. It's just that ONLY one thing they looked at- with an HR also of .5- had the magic statistical significance, with a P value below .05, whereas the others, which also had HRs of .5 or .6. only got a P value of .1. Thus, they are declared to not exist, no benefit.
I find such as that to be very misleading. I think any rational person, including you, me and these researchers, are going to choose the treatment that has the better HR, even if it does not quite sneak into the statistical significance area with a .05, but only scores a .06 or even .1. Because there ARE actual benefits there, and they might be worth having. The only way most of us are gong to choose the treatment with a higher HR is( as you have agreed at least for yourself) if there are some worse SEs to deal with with the treatment that has superior HR. Depending on how severe, we might even still choose the superior HR if the SE difs are not big, regardless of not quite making statistical significance.
But if we were to go by the head lined results of these studies, we would think - just as they herald- "No Benefit". And unless we had some one to warn us(or unless we are the type to dig into the studies) that one group indeed had a PC death rate that was only 1/2 as high as the other group, we might well choose the other group with the higher death rate, even if the SEs were the same, and for sure if they were even slightly less. Why would we choose the one with the superior HR when they said "we did not find a difference in their survival from prostate cancer or in their survival without metastatic disease"? But I think if I had all the info I might still choose the group with the higher survival rate, though I might not if the SE dif was too great.
Post Edited (BillyBob@388) : 4/29/2019 12:56:52 PM (GMT-6)