• The best paper on comparative effectiveness research of prostate cancer treatments

    I don’t do this much because it’s mean to those of you for whom the following paper is gated:* Comparative effectiveness research in localized prostate cancer treatment, by Richard Hoffman, David Penson, Anthony Zietman, and Michael Barry, is so well done I’m not even going to quote it. I wouldn’t know where to stop. Just go get it and read it if you can* and if you’re interested in this subject.

    To my eye, they covered every base and correctly. They summarized every major prostate cancer treatment RCT and the important observational studies. They assessed strengths and limitations of various, standard research design methodologies. There is no other paper on this subject that impresses me as much as this one. It’s pretty much the only thing you need to cite for almost any point you’d want to make about the study of health and quality of life outcomes of prostate cancer treatments. Bravo!

    That is all.

    * For a limited time, the editor has ungated this paper (see comments). Go get it.

    @afrakt

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    • When are they going to stop paying extra for proton beam therapy?

    • Can you, within the limits of copyright law and ethics, summarize their conclusions?

    • Hi all

      I am the Commissioning Editor of this publication (Journal of Comparative Effectiveness Research), and we’re delighted to hear these positive comments on the article. We’d be happy to to make the article free to access on our website for a month, to make it available to as many readers as possible (see: http://www.futuremedicine.com/toc/cer/2/6).

      Please feel free to share this information with any colleagues you think would benefit.

      Thanks!

    • After getting hold of the paper (thank you Laura! it is an excellent paper and covers the previous literature better than any that has come before it. The lack of an RCT to compare treatments, especially compared to active surveillance, is a severe worry, and will be going forward regardless of PSA rates for asymptomatic prostate cancer.

      I would suggest another paper not referenced, by Dr Anirban Basu (warning, very wonkish) which uses an new statisitcal method, treating individuals heterogeneously with regards to outcomes, when comparing active surveillance to prostatectomy. http://onlinelibrary.wiley.com/doi/10.1002/jae.2343/abstract (apologies if gated).

    • While the paper provides a thorough review, I guess I am a little confused about its conclusions. Now, I preface this by saying I am not a physician so maybe I am just in the dark — but it seems like most of the conclusions are based on the ability to effectively separate out the high risk cancers from the low risk cancers. I was under the impression that the whole “over-treatment” issue with prostate cancer was that the PSA was very poor at doing this.

      Since the authors rely on a combination measure that includes the PSA, I assume that the combination measure itself has been tested and shown to be reasonably accurate in separating high risk from low risk?