Long-term follow-up results from the phase III Prostate Cancer Intervention Versus Observation Trial (PIVOT) indicated that radical prostatectomy does not significantly reduce all-cause or prostate cancer mortality compared with observation through nearly 20 years, according to findings presented at the 2017 American Urological Association Annual Meeting. The results demonstrated that there was not a statistically significant difference in all-cause mortality between patients who received surgery and those who were kept under observation (P = .06).
However, prostate cancer mortality did vary based on tumor characteristics. Prostate cancer mortality was observed in 4.8% of low-risk patients, 12.2% of intermediate-risk patients, and 15.9% of high-risk patients.
This is a very difficult problem but this study raises insightful questions. Much of medicine is aimed at the margins of disease, that is those people whose disease is on the periphery of the generality. Many illnesses with relatively good general long term results have, in a certain percentage, significant risk. Medicine tends to treat the general group for that specific, small risk. As cost increase, look to this caution as an area for bureaucrats to attack.
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