UroToday - AUA 2008 - The Tyrol Prostate Cancer Demonstration Project (1988 – 2007): Morbidity and Mortality

[Guest guest]

Monday, 26 May 2008

ORLANDO, FL (UroToday.com) - Although reduction in prostate cancer mortality

rates is important, it is necessary to consider the effects of prostate cancer

screening and treatment on patient quality of life. Potential gains in survival

could be more than offset decrements in quality of life that may result from

diagnosis and treatment.

In 1988, the concept of early detection and curative radical therapy for

prostate cancer was introduced in the Tyrol. In 2005 a cumulative testing rate

of 86.6% was achieved. Overall 7439 TRUS guided biopsies were performed; before

1998 ten biopsies were performed using contrast-enhanced color Doppler

ultrasound. In men with organ-confined lesions, surgical removal of the prostate

was recommended. 89.3% of patients with T1 or T2 disease were treated with

low-morbidity radical prostatectomy, 5.7% with brachytherapy, and 4.7% with

radiotherapy. Between 1988 and 2007 2003 radical prostatectomies were performed

mostly by two surgeons (G.B., W.H.). Patients presenting with T3 lesions

underwent external beam radiotherapy.

Radical prostatectomy has been associated with low morbidity; 30-day mortality

was zero and one of the patients suffered a ureteral injury. The rectal injury

rate dropped to 0.1% from 0.6% before the year 2000. Only 0.7% of the patients

had postoperative bleeding requiring intervention. One year after surgery, 95.1%

of men were continent (no pads) and potency could be preserved in 78.9% of men

below 65 years of age. The morbidity associated with TRUS guided biopsy was low;

major complications were seen in a small percentage of patients only (0.5% of

patients with fevers higher than 100.4 degrees F requiring hospitalization).

Since 1996 a significant reduction in mortality from prostate cancer has been

observed in the Tyrol. In the years 2003 - 2005 prostate cancer mortality rates

decreased by 48%, 55%, and 52%, respectively.

The investigators conclude that these findings confirm the hypothesis that

freely available PSA testing, which has met with wide acceptance in the

population, is associated with a reduction in prostate cancer mortality in an

area where effective treatment is freely available to all men. It is likely that

much of this decline in mortality rates is due to earlier detection and

successful treatment of prostate cancer. However, an important corollary of this

study is that screening is only the first step in the optimal management of

prostate cancer.

Presented by Georg Bartsch, MD, Wolfgang Horninger, MD, Helmut Klocker, MD,

Wilhelm Oberaigner, MD, Georg Schaefer, MD, Ferdinand Frauscher, MD, Chris

on, MD, Boyle, MD, at the Annual Meeting of the American Urological

Association (AUA) - May 17 - 22, 2008. Orange County Convention Center -

Orlando, Florida, USA.

=====================================================

For info on managing your subscription: http://ppml-info.org/welcome.html

Need more help? Send email to: prostate-request@...

[Guest guest]

If I am interpreting this release

correctly, of the 7,349 men who were biopsied in this study in a nineteen year

period, 2,280 were diagnosed with PCa – that’s a ‘strike rate’ of about 30%

which is what one would expect from the studies published in the USA. And,

again, if I have understood this correctly, that would mean an average of about

117 men per annum – a fairly small data pool compared with the estimated number

of men diagnosed in the USA, where a commonly used figure is 200,000 men per

annum.

 But the bit I can’t understand – and I

really would appreciate it if someone more statistically literate could explain

it for me is this:

<snip> Since 1996 a significant

reduction in mortality from prostate cancer has been observed in the Tyrol. In the years 2003 - 2005 prostate cancer mortality

rates decreased by 48%, 55%, and 52%, respectively. <snip>

I know that it is claimed that mortality

rates have been decreasing ever since this study was started in 1988 – twenty years

ago, so at what level, was the disease specific mortality at 2002 - compared

with the level prior to 1988 or is it 1996 when the significant reduction in

mortality rates was noted? And then is it claimed that the 2003 figure was 52%

of the 2002 figure; the 2004 figure 45% of the 2003 figure; the 2005 figure 48%

of the 2004 figure. I am sure it can’t be this because the mortality rate would

be close to zero by now if that was so.

I assume therefore that the percentages

quoted represent a percentage of the historical mortality rate – pre 1988 or

pre 1996? But if this is the case then over the three years quoted the rate

didn’t decrease consistently – it increased from 2003 – 2004 and then reduced

from 2004 – 2005 to a higher level than it was in 2003.

Perhaps this is the kind of variance that

is statistically ignorable with such a small data base?

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since then.

My sites are at www.yananow.net  and www.prostatecancerwatchfulwaiting.co.za 

Dr

“Snuffy†Myers :

" As a physician, I am painfully aware that most of the decisions we make

with regard to prostate cancer are made with inadequate data "

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Kathy Meade

Sent: Friday, 6 June 2008 11:09 AM

To: Kathy Meade

Subject:

UroToday - AUA 2008 - The Tyrol Prostate

Cancer Demonstration Project (1988 – 2007): Morbidity and Mortality

Monday, 26 May 2008

ORLANDO, FL

(UroToday.com) - Although reduction in prostate cancer mortality rates is

important, it is necessary to consider the effects of prostate cancer screening

and treatment on patient quality of life. Potential gains in survival could be

more than offset decrements in quality of life that may result from diagnosis

and treatment.

In 1988, the concept of early detection and curative radical therapy for

prostate cancer was introduced in the Tyrol.

In 2005 a cumulative testing rate of 86.6% was achieved. Overall 7439 TRUS

guided biopsies were performed; before 1998 ten biopsies were performed using

contrast-enhanced color Doppler ultrasound. In men with organ-confined lesions,

surgical removal of the prostate was recommended. 89.3% of patients with T1 or

T2 disease were treated with low-morbidity radical prostatectomy, 5.7% with

brachytherapy, and 4.7% with radiotherapy. Between 1988 and 2007 2003 radical

prostatectomies were performed mostly by two surgeons (G.B., W.H.). Patients presenting

with T3 lesions underwent external beam radiotherapy.

Radical prostatectomy has been associated with low morbidity; 30-day mortality

was zero and one of the patients suffered a ureteral injury. The rectal injury

rate dropped to 0.1% from 0.6% before the year 2000. Only 0.7% of the patients

had postoperative bleeding requiring intervention. One year after surgery,

95.1% of men were continent (no pads) and potency could be preserved in 78.9%

of men below 65 years of age. The morbidity associated with TRUS guided biopsy

was low; major complications were seen in a small percentage of patients only

(0.5% of patients with fevers higher than 100.4 degrees F requiring

hospitalization). Since 1996 a significant reduction in mortality from

prostate cancer has been observed in the Tyrol.

In the years 2003 - 2005 prostate cancer mortality rates decreased by 48%, 55%,

and 52%, respectively.

The investigators conclude that these findings confirm the hypothesis that

freely available PSA testing, which has met with wide acceptance in the

population, is associated with a reduction in prostate cancer mortality in an

area where effective treatment is freely available to all men. It is likely

that much of this decline in mortality rates is due to earlier detection and

successful treatment of prostate cancer. However, an important corollary of

this study is that screening is only the first step in the optimal management

of prostate cancer.

Presented by Georg Bartsch, MD, Wolfgang Horninger, MD, Helmut Klocker, MD, Wilhelm

Oberaigner, MD, Georg Schaefer, MD, Ferdinand Frauscher, MD, on,

MD, Boyle, MD, at the Annual Meeting of the American Urological

Association (AUA) - May 17 - 22, 2008. Orange

County Convention

Center - Orlando,

Florida, USA.

=====================================================

For info on managing your subscription: http://ppml-info.org/welcome.html

Need more help? Send email to: prostate-requestlistserv (DOT) acor.org

[Guest guest]

If I am interpreting this release

correctly, of the 7,349 men who were biopsied in this study in a nineteen year

period, 2,280 were diagnosed with PCa – that’s a ‘strike rate’ of about 30%

which is what one would expect from the studies published in the USA. And,

again, if I have understood this correctly, that would mean an average of about

117 men per annum – a fairly small data pool compared with the estimated number

of men diagnosed in the USA, where a commonly used figure is 200,000 men per

annum.

 But the bit I can’t understand – and I

really would appreciate it if someone more statistically literate could explain

it for me is this:

<snip> Since 1996 a significant

reduction in mortality from prostate cancer has been observed in the Tyrol. In the years 2003 - 2005 prostate cancer mortality

rates decreased by 48%, 55%, and 52%, respectively. <snip>

I know that it is claimed that mortality

rates have been decreasing ever since this study was started in 1988 – twenty years

ago, so at what level, was the disease specific mortality at 2002 - compared

with the level prior to 1988 or is it 1996 when the significant reduction in

mortality rates was noted? And then is it claimed that the 2003 figure was 52%

of the 2002 figure; the 2004 figure 45% of the 2003 figure; the 2005 figure 48%

of the 2004 figure. I am sure it can’t be this because the mortality rate would

be close to zero by now if that was so.

I assume therefore that the percentages

quoted represent a percentage of the historical mortality rate – pre 1988 or

pre 1996? But if this is the case then over the three years quoted the rate

didn’t decrease consistently – it increased from 2003 – 2004 and then reduced

from 2004 – 2005 to a higher level than it was in 2003.

Perhaps this is the kind of variance that

is statistically ignorable with such a small data base?

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since then.

My sites are at www.yananow.net  and www.prostatecancerwatchfulwaiting.co.za 

Dr

“Snuffy†Myers :

" As a physician, I am painfully aware that most of the decisions we make

with regard to prostate cancer are made with inadequate data "

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Kathy Meade

Sent: Friday, 6 June 2008 11:09 AM

To: Kathy Meade

Subject:

UroToday - AUA 2008 - The Tyrol Prostate

Cancer Demonstration Project (1988 – 2007): Morbidity and Mortality

Monday, 26 May 2008

ORLANDO, FL

(UroToday.com) - Although reduction in prostate cancer mortality rates is

important, it is necessary to consider the effects of prostate cancer screening

and treatment on patient quality of life. Potential gains in survival could be

more than offset decrements in quality of life that may result from diagnosis

and treatment.

In 1988, the concept of early detection and curative radical therapy for

prostate cancer was introduced in the Tyrol.

In 2005 a cumulative testing rate of 86.6% was achieved. Overall 7439 TRUS

guided biopsies were performed; before 1998 ten biopsies were performed using

contrast-enhanced color Doppler ultrasound. In men with organ-confined lesions,

surgical removal of the prostate was recommended. 89.3% of patients with T1 or

T2 disease were treated with low-morbidity radical prostatectomy, 5.7% with

brachytherapy, and 4.7% with radiotherapy. Between 1988 and 2007 2003 radical

prostatectomies were performed mostly by two surgeons (G.B., W.H.). Patients presenting

with T3 lesions underwent external beam radiotherapy.

Radical prostatectomy has been associated with low morbidity; 30-day mortality

was zero and one of the patients suffered a ureteral injury. The rectal injury

rate dropped to 0.1% from 0.6% before the year 2000. Only 0.7% of the patients

had postoperative bleeding requiring intervention. One year after surgery,

95.1% of men were continent (no pads) and potency could be preserved in 78.9%

of men below 65 years of age. The morbidity associated with TRUS guided biopsy

was low; major complications were seen in a small percentage of patients only

(0.5% of patients with fevers higher than 100.4 degrees F requiring

hospitalization). Since 1996 a significant reduction in mortality from

prostate cancer has been observed in the Tyrol.

In the years 2003 - 2005 prostate cancer mortality rates decreased by 48%, 55%,

and 52%, respectively.

The investigators conclude that these findings confirm the hypothesis that

freely available PSA testing, which has met with wide acceptance in the

population, is associated with a reduction in prostate cancer mortality in an

area where effective treatment is freely available to all men. It is likely

that much of this decline in mortality rates is due to earlier detection and

successful treatment of prostate cancer. However, an important corollary of

this study is that screening is only the first step in the optimal management

of prostate cancer.

Presented by Georg Bartsch, MD, Wolfgang Horninger, MD, Helmut Klocker, MD, Wilhelm

Oberaigner, MD, Georg Schaefer, MD, Ferdinand Frauscher, MD, on,

MD, Boyle, MD, at the Annual Meeting of the American Urological

Association (AUA) - May 17 - 22, 2008. Orange

County Convention

Center - Orlando,

Florida, USA.

=====================================================

For info on managing your subscription: http://ppml-info.org/welcome.html

Need more help? Send email to: prostate-requestlistserv (DOT) acor.org

[Guest guest]

If I am interpreting this release

correctly, of the 7,349 men who were biopsied in this study in a nineteen year

period, 2,280 were diagnosed with PCa – that’s a ‘strike rate’ of about 30%

which is what one would expect from the studies published in the USA. And,

again, if I have understood this correctly, that would mean an average of about

117 men per annum – a fairly small data pool compared with the estimated number

of men diagnosed in the USA, where a commonly used figure is 200,000 men per

annum.

 But the bit I can’t understand – and I

really would appreciate it if someone more statistically literate could explain

it for me is this:

<snip> Since 1996 a significant

reduction in mortality from prostate cancer has been observed in the Tyrol. In the years 2003 - 2005 prostate cancer mortality

rates decreased by 48%, 55%, and 52%, respectively. <snip>

I know that it is claimed that mortality

rates have been decreasing ever since this study was started in 1988 – twenty years

ago, so at what level, was the disease specific mortality at 2002 - compared

with the level prior to 1988 or is it 1996 when the significant reduction in

mortality rates was noted? And then is it claimed that the 2003 figure was 52%

of the 2002 figure; the 2004 figure 45% of the 2003 figure; the 2005 figure 48%

of the 2004 figure. I am sure it can’t be this because the mortality rate would

be close to zero by now if that was so.

I assume therefore that the percentages

quoted represent a percentage of the historical mortality rate – pre 1988 or

pre 1996? But if this is the case then over the three years quoted the rate

didn’t decrease consistently – it increased from 2003 – 2004 and then reduced

from 2004 – 2005 to a higher level than it was in 2003.

Perhaps this is the kind of variance that

is statistically ignorable with such a small data base?

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since then.

My sites are at www.yananow.net  and www.prostatecancerwatchfulwaiting.co.za 

Dr

“Snuffy†Myers :

" As a physician, I am painfully aware that most of the decisions we make

with regard to prostate cancer are made with inadequate data "

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Kathy Meade

Sent: Friday, 6 June 2008 11:09 AM

To: Kathy Meade

Subject:

UroToday - AUA 2008 - The Tyrol Prostate

Cancer Demonstration Project (1988 – 2007): Morbidity and Mortality

Monday, 26 May 2008

ORLANDO, FL

(UroToday.com) - Although reduction in prostate cancer mortality rates is

important, it is necessary to consider the effects of prostate cancer screening

and treatment on patient quality of life. Potential gains in survival could be

more than offset decrements in quality of life that may result from diagnosis

and treatment.

In 1988, the concept of early detection and curative radical therapy for

prostate cancer was introduced in the Tyrol.

In 2005 a cumulative testing rate of 86.6% was achieved. Overall 7439 TRUS

guided biopsies were performed; before 1998 ten biopsies were performed using

contrast-enhanced color Doppler ultrasound. In men with organ-confined lesions,

surgical removal of the prostate was recommended. 89.3% of patients with T1 or

T2 disease were treated with low-morbidity radical prostatectomy, 5.7% with

brachytherapy, and 4.7% with radiotherapy. Between 1988 and 2007 2003 radical

prostatectomies were performed mostly by two surgeons (G.B., W.H.). Patients presenting

with T3 lesions underwent external beam radiotherapy.

Radical prostatectomy has been associated with low morbidity; 30-day mortality

was zero and one of the patients suffered a ureteral injury. The rectal injury

rate dropped to 0.1% from 0.6% before the year 2000. Only 0.7% of the patients

had postoperative bleeding requiring intervention. One year after surgery,

95.1% of men were continent (no pads) and potency could be preserved in 78.9%

of men below 65 years of age. The morbidity associated with TRUS guided biopsy

was low; major complications were seen in a small percentage of patients only

(0.5% of patients with fevers higher than 100.4 degrees F requiring

hospitalization). Since 1996 a significant reduction in mortality from

prostate cancer has been observed in the Tyrol.

In the years 2003 - 2005 prostate cancer mortality rates decreased by 48%, 55%,

and 52%, respectively.

The investigators conclude that these findings confirm the hypothesis that

freely available PSA testing, which has met with wide acceptance in the

population, is associated with a reduction in prostate cancer mortality in an

area where effective treatment is freely available to all men. It is likely

that much of this decline in mortality rates is due to earlier detection and

successful treatment of prostate cancer. However, an important corollary of

this study is that screening is only the first step in the optimal management

of prostate cancer.

Presented by Georg Bartsch, MD, Wolfgang Horninger, MD, Helmut Klocker, MD, Wilhelm

Oberaigner, MD, Georg Schaefer, MD, Ferdinand Frauscher, MD, on,

MD, Boyle, MD, at the Annual Meeting of the American Urological

Association (AUA) - May 17 - 22, 2008. Orange

County Convention

Center - Orlando,

Florida, USA.

=====================================================

For info on managing your subscription: http://ppml-info.org/welcome.html

Need more help? Send email to: prostate-requestlistserv (DOT) acor.org