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Watchful Waiting vs. Invasive Treatments

Date: Wed, 26 Nov 1997 23:45:39 -0600
From: Scott Matthew <realty@EXCEL.NET>
Subject: Ralph Valle's chart on effectiveness

Ralph Valle wrote:
>Here is a table of results comparing surgery with conservative
>management from that reference:

Thanks Ralph. But let me get this straight. According to this study, RT is killing people with Gleason scores of 2-7? It doesn't just not help, it kills extra people by the end of 10 years? (4 out of every 200?). I'm especially against treatments that kill extra people. And we're putting 100 men with Gleason 2-4 through the horror of RP, so that 94 of them will be alive at 10 years, instead of 93? Check your Table 1 and see if I've miss-read it.

>TABLE 1

>10-year disease-specific survival (%) in patients with localized PCa (95% CI) by Grade.

>Grade RP RT Conservative
>1 94 90 93
>2 87 76 77
>3 67 53 45
>Patients 20.5 12.7 19.9
>(all grades)
>in thousands


>Grades are defined as follows:
>Grade 1: Gleason 2 to 4
>Grade 2: Gleason 5 to 7
>Grade 3: Gleason 8 to 10


>As you can see there is improvement in survival by treatment. Alas, longevity IS increased! The effect of treatment on survival is more pronounced in more aggressive disease.

>Hang in there Scott, we all need to be challenged from time to time, otherwise we become complaisant and mentally stagnant. Godspeed,

>Ralph

Even if these number stand up, which will surprise me since others don't seem to go the same way, RP seems way too terrible a thing for these meager "success" numbers. If you were grade 1, would you choose to live 10 years incontinent and impotent for a 1% better chance of survival? I wouldn't.

The effects of RP we read about are miserable, including:

• "Over 30% reported currently wearing pads or clamps to deal with wetness
• over 40% said they drip urine when they cough or when their bladders are full
• 23% reported daily wetting of more than a few drops
• About 60% of patients reported having no full or partial erections since their surgery
• only 11% had any erections sufficient for intercourse during the month prior to the survey
• 6% had surgery after the radical prostatectomy to treat incontinence
• 15% had treatments or used devices to help with sexual function
• 20% report having had post-surgical treatment for urethral strictures
• 16%, 22%, and 28% reported follow-up treatment for cancer (radiation or androgen deprivation therapy) at two, three, and four years after radical prostatectomy."

The above are from "Patient-Reported Complications and Follow-up Treatment after Radical Prostatectomy" by Floyd J. Fowler, Jr., Ph.D. et al from the Center for Survey Research, Univ. of Mass.]

And we should know that:
"Events (such as incontinence and impotence) occur at rates that are generally HIGHER than those typically reported in the literature" Journal of The National Cancer Institute, February 21, 1996, Vol 88.

Besides that, RT is an accepted, standard treatment, suffered through by many readers here, and yet your study shows that at 10 years it does no good, and kills some extra people. 12,000 people were radiated by well meaning doctors, and it did no good. Plus the terrible side effects.

This is all I'm saying, Ralph. I'm "underwhelmed" by this proof of success. Is it enough to save a few percent extra, if we have to mutilate all the rest to do it -- men who would have been fine otherwise? (And since death rates are not changing in the high RP state versus the low RP state so far, and we've been doing this a long time, I don't think it's really doing anyone any good.) But if these number turn out to be solid gold, they still say to ME "don't let them do that terrible thing to you!"

I've read that 40% of men above age 60 have prostate cancer, yet only 8 to 10% of men will ever have a symptom of prostate cancer and only 3% of men die from prostate cancer.

Would you, based on these numbers, recommend RP for 40% of men over 60? But as we all agree here, we each take the info, and make our own call. Other people's choices are their choices. Not my business to question. But Frankly, I still worry about that Grade 1 guy talked into an RP, when you know it's a mistake. Not maybe a mistake. Not might be a mistake. It's a terrible mistake. And it happens every day. And based on your study, I worry about all those people being radiated for no reason. (And that poor 2 % of grade 1 & 2 who are dying because of the treatment!)

Very Best to you

Scott

---

From: LARRY CLAPP <lclapp@prostate90.com>
To: Prostate Problems Discussion <PROSTATE@MAELSTROM.STJOHNS.EDU>
Date: Thursday, November 27, 1997 5:43 PM
Subject: WW vs Invasive Treatments

Dear Scott, et al,

I want to applaud all of you for carrying on this week long, debate for the benefit of a lot of men who never get to hear these analysis's and certainly not in this detail and intelligence with citations. It should be posted and indexed for all "newbies" to make more informed decisions. I too worry "about that Grade 1 guy talked into an RP, when you know it's a mistake. Not maybe a mistake. Not might be a mistake. It's a terrible mistake. And it happens every day. And based on your study, I worry about all those people being radiated for no reason. (And that poor 2 % of grade 1 & 2 who are dying because of the treatment!)"

I couldn't agree more to respect each man's decision for whatever treatment or WW. In my own case I decided upon watchful waiting, augmented by every credible alternative modality I could find in this country and several others. I was driven by initial research showing that most cultures do not have prostate problems, it being mostly a problem of Western civilization. I have studied and learned a great deal -- it worked dramatically for me and now for many others.

I would therefore add to the options, particularly for those inclined to WW, that they commit to a program of cleansing the toxins that cause the cancer in the first place and strengthening the immune system.. There are no side effects, very little cost and the end result is a far healthier and happier man with greatly increased sexual capabilities. There is no downside that I am aware of. Monitored by monthly PSA's and/or other non-invasive tests, there is little or no increased risk and the turn around is very fast, with PSA's dropping dramatically the first month, often to normal. Enlarged prostates quickly return to a normal size, shape and texture. Quality of life is dramatically enhanced, instead of eroded or worse. There is always the option of medical treatment at any time, and the man will be healthier and stronger from the cleansing and strengthening, to have a better medical result.

The program is simple, requiring mostly commitment. It is too long to detail here, however much of it is available at www.prostate90.com and is fully spelled out in "how to", detail, in my book. My research shows that if the causes of the cancer are not addressed, it will return, in some form in 5-10 years, regardless of the mode of treatment. Relapse figures tend to confirm this, and they don't track the other forms.

Again my thanks to all of you for the intelligent debate. I hope it will continue and be made readily available to all Pca patients facing these difficult, highly personal decisions.

Be in Great Health,

Larry Clapp, Ph.D., J.D.