RT/RP vs RT/ADT OCSS (overall cancer-specific survival)

What am I missing? Looks like RP with RT OCSS is a fraction of OS (overall survival). I have looked at multiple studies and they all seem to show the same type of thing.

a.10-year survival after RT/ADT or RT/RP (comparing overall mortality (PCa, cardiac, etc) to PCa mortality for RT/ADT vs. RT/RP)

"The ten-year prostate cancer–specific survival rate for men undergoing radical prostatectomy plus radiotherapy was 89 percent compared to 74 percent in the group undergoing radiotherapy plus androgen deprivation therapy. Overall ten-year survival rates were 64 and 48 percent, respectively."

b.mskcc.org/clinical-updates/...

[Tall_Allen]

What you're missing is level of evidence.

[mrscruffy]

Where they for comparable age groups?

[Hidden in reply to mrscruffy]

The one posted is for 65+. I'm 59 so my stats would be different. Another thing that inherently confounds any study of 10-year results is that, if it is based on actual results, the technology used is 10+ years old.

From: grandroundsinurology.com/th...

RT results

[mrscruffy in reply to Hidden]

The other thing that I wonder about is were they diagnosed early(I was because my dad passed from this crap) or were they diagnosed way late. Have a friend diagnosed same time as me but it was way further along. He is in bad shape I am great relatively speaking

[doc1947g in reply to Hidden]

It is for Brachytherapy and for men =< 60 y.o.

[Hidden in reply to doc1947g]

Thanks.

I clarified my response.

[Don_1213]

As TA said - level of evidence. I'd also argue the study is flawed simply by the age difference typical between RP/RT patients and RT/ADT patients. Especially since this mornings readings were pretty convincing on showing that increasing age = higher risk cancer.

From this study:

"Observational Study Limitations

Since this analysis was observational and patients were not randomized to treatment approaches, the findings are directional. SEER data is designed for billing purposes, so crucial information that may influence the results, such as radiation dosage or whether patients received nerve-sparing surgery, is not precisely captured. Using Medicare claims to measure adverse events is a crude estimate, since codes may not be specific enough to capture diagnoses or procedures related to complications. (1)

Finally, it is important to note that since 2009, the last year for data capture in this observational study, there have been many advances in prostate cancer surgery and radiotherapy approaches that have served to improve outcomes further while reducing adverse events, such as erectile dysfunction and urinary incontinence."

So the data used is rather non-specific and basically flawed, out of date, and time has improved treatments overall. Making the paper pretty much useless for any intelligent decisions. But that's just me..

[Hidden in reply to Don_1213]

I agree that 10 year OS data is inherently using 10+-year-old technology. The second study I posted is for guys under 60. I would venture a guess that if old tech used on older guys shows an 80% CSS that new tech on a guy under 60 would show a better CSS.

I'm trying to read between the lines but often times we have to make decisions based on imperfect inputs. I wondered if there was anything glaring that stood out like perhaps I made a mistake in what CSS and OS mean.