A prostate cancer bumper edition

ICYMI here’s a suite of studies – principally the ProtecT study.

I’m told this is the most expensive trial ever. Which concluded that no difference in prostate specific cancer survival between three arms – active surveillance, radiotherapy, surgery.

(Remember we know that robotic surgery is no better than standard surgery – study earlier this year)

I know……lets buy lots of proton beam therapy and da Vinci robots

Oh and with all the spare capacity we can let the robots and protons free in other specialties and other surgical indications (with equally zero evidence of gain and mega cost)

I despair
Is it any wonder we are broke
Is it any wonder why the budget for specialised is continually overspent (ref HSC report, NAO, I could go on). It’s not just a prostate issue, it’s generalised.

Lesson = don’t let it in till full evaluation.

Yes that’s anti innovation (or is it anti invention), but equally it’s pro funding stuff for those that morally bear the brunt of the opportunity cost….. You know, mental health services, general practice, social care, prevention of stuff….things like that

It’s in now, we can’t stop. We spend a lot in this area. For some it does good, for many it does harm…….stop and think about that…..the balance of good and harm in healthcare is rather a delicate thing. We often underplay the harm issue…..

And then we play in cost, and opportunity cost. Opportunity also counts as harm, in terms of what others are denied.

Rant over

Refs

1)

10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer — NEJM

No survival differences between arms

2)

Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer — NEJM

Patient report outcomes deteriorate in all three groups in a way that you’d expect

Invasive treatment leads to more complications and worse outcomes.

3)

Editorial

To be fair there are some nuances here that do warrant attention – esp age and risk stratified and re metastatic disease. Helpful in shared decision making,

Treatment or Monitoring for Early Prostate Cancer — NEJM

4)
NIHR write up

5)

Science media centre

expert reaction to two studies reporting results on monitoring prostate cancer versus surgery or radiotherapy, and survival and cancer progression | Science Media Centre

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