I came across an interesting example of why it can be worthwhile to dig into the details that underlie statistic-based conclusions. (And I wasn't really digging that hard, this one fell into my lap.)
In considering anti-androgen monotherapy as an initial systemic treatment for my metastatic 3+4=7 PC, I found some of the studies investigating AAM excluded patients with mets. They did so because it is considered that Casodex alone is inferior to standard ADT as regards overall survival of these men.
Naturally, this "fact" would discourage anyone (or any MO) from moving forward with AAM in metastastic PC. But I did notice many of the papers were referencing one particular study when they stated that Casodex had an inferior survival profile. One paper I stumbled across, though, observed the following about that particular study: follow up was at just 100 weeks, the statistical survival benefit was less than 8 weeks, and the survival benefit of ADT disappeared in the subset of men with a PSA lower than 400.
So if just diagnosed, you have mets and your PSA is over 400, and you expect to live for only two years but feel strongly about living an additional two months beyond that, do not use AAM as your initial therapy?
I'm not sure what else to definitively conclude about the "fact" that Casodex is an inferior treatment for men with mets.
It sure doesn't surprise me that men with a very advanced, heavy late-stage tumor burden who are near death may see inferior outcomes with this mode of treatment. But should we extrapolate from that to conclude that oligometastatic men with less advanced disease and far lower PSAs will also have inferior overall survival?
That seems to be the conclusion other researchers must start from if they take the overall results of the study at face value. Only those who dissect the study can conclude that OS inferiority was not shown for some subgroups of men.
I think it is worth remembering that treatment effectiveness and overall survival for any individual man may or may NOT be reflected by the aggregate statistical conclusions of some studies, especially if different conclusions can be reached for different subgroups of men within those studies.
Even though a study itself may mention the different outcomes for different subgroups, such nuance can be ignored when those studies are referenced by others. This is pretty much how the medical community arrived at the unquestioned dogma that the administration of exogenous testosterone necessarily causes PC progression and must be avoided always and everywhere in all men with PC.
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noahware
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Not many people are able to g o deep enough to understand the manipulation the financiers of clinical trials create.
Go to research studies in 1990s when Casodex was a new med and was branded. The reseach from those times concluded that Casodex was as effective as Lupron in Metastatic PCa.
Then came 2000s and suddenly studies started badmouthing Caodex and started singing praise for Lupron.
Then, comes 2010-20...Lupron became NOT enough you have to add Abiraterone or new Lutamides to live longer.
NOBODY is telling us that very strong suppression of testosterone causes Androgen Resistant cancer cells and those are very hard to treat. Ony Dr Larry Klotz told us this recently. Only very recently, Dr Leslie Castello and his team came forward to treat these cancer cells with old medicine, Cabergolin and ionic Zinc (use with Zinc Ionophores)
Is it not kind of disgusting that these clinical trialers do not talk about anti cancer foods, exercise , deep breathing and relaxation , herbs and spices which are also effective in slowing cancer progression. Not enough profits here.
Most people are very fearful of death and they are dangled 3 or 4 months of prolonged (but miserable) life and they are willing to spend their life's savings and their children's future.
I admire you about thinking deeply and critically about Onc Industrial sponsored clinical trials. AS long as corporate profits take preference over peoples lives and wellbeing , we can not be a happy country.
BTW, I am now only on Casodex along with my bunch of herbs, spices, leaves, roots and regular physical excercise with deep relaxing meditation et.c. I am 3=4=7 like you. My PSA is 0.3 and I am watching it every 2 weeks. Lets see what happens in coming months.
I should add that I came across one particular paper that seemed intent on over-stating any negative potential for the use of Casodex (bicalutamide).
At the very bottom, the sponsor of this "research" was noted. Yup... brought to you by the makers of the (very expensive and not-yet generic) competing newer anti-androgen drug enzalutamide (Xtandi).
It's one thing if you are lucky enough to have your drugs paid for with Other People's Money, but I feel bad for people paying out of pocket who might be told incorrectly that Xtandi is their only good option.
Bravo, big pharma has doctors bypassing older very effective drugs for newer very expensive drugs. They have to make their money before the Patent runs out.
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