There has been a lot of media hype in Europe around the re-presentation of the PIVOT data by Dr. Wilt at the annual meeting of the European Association of Urology in Paris last week. And yet every prostate cancer specialist attending that meeting must have already been well aware of these data.
Assiduous readers of the is column will know that these data were first presented nearly a year ago at the annual meeting of the American Urological Association in Washington. DC in May 2011. (Click here to see our original report from that meeting.) There is nothing new in the report presented by Dr. Wilt last week. He has presented these data several times in the past 12 months at a number of major medical meetings and other prostate cancer-specific meetings.
In the view of The “New” Prostate Cancer InfoLink, it is becoming embarrassing that the full data from the PIVOT trial are still unpublished nearly 12 months after their initial presentation. The PIVOT trial is an important study, but the Devil is in the details … and as yet the details from this trial remain unpublished.
Here is just one link to the sort of commentary that Europeans have been seeing in their newspapers over the past 3 or 4 days.
Filed under: Diagnosis, Management, Risk, Treatment | Tagged: Management, obseration, PIVOT, risk, surgery, surveillance, Treatment |
THE "NEW" PROSTATE CANCER INFOLINK 
The linked article ends with:
“The charity added around 250,000 men are currently living with prostate cancer in the UK, with one man dying from it every hour.”
I thought I read somewhere that prostate cancer deaths were about 40% higher in the UK than in the US. (Not sure what the details behind that statistic might be).
Dear Doug:
After a quick bit of web research (see http://seer.cancer.gov/statfacts/html/prost.html and http://info.cancerresearchuk.org/cancerstats/types/prostate/, I can tell you that:
— The age-adjusted incidence of prostate cancer in the USA for the period 2005-2009 is estimated at 154.8 per 100,000
— The age-adjusted incidence of prostate cancer in the UK in 2009 is estimated at 97.9 per 100,000
— The age-adjusted mortality of prostate cancer in the USA for the period 2005-2009 is estimated at 23.7 per 100,000
— The age-adjusted mortality of prostate cancer in the UK in 2009 is estimated at 23.6 per 100,000
The (much) lower incidence rate in the UK can easily be explained by the much lower frequency of individual screening. You will note, however, that the difference in screening rates apparently has minimal effect on the relative mortality rates.
But Mike, I hear from many Brits that America is overweight and has terrible dietary habits. If such is true, then also true is the possibility that early diagnosis and treatment have kept the US from elevating above the British cancer statistics.
Sitemaster,
The PIVOT trial would appear to be attempting to quantify risks of action or inaction at the treatment decision stage — the area of interest I arrived at (18 years later) in the recent ERSPC discussion on InfoLink.
I note with interest the PIVOT summary results after 12 years and the discussion on InfoLink last year. PIVOT results so far do seem to indicate caution on precipitous action for many men diagnosed with prostate cancer. I hope they maintain the project for 15 or 20 years to get the longer-term picture as well.
There appears to be some detail in the summary results but you indicate there may be a lot more — and the Devil may be in the detail. Also, why do they keep re releasing the summary results. Is there any way of finding out their future plans and info releases for this project? It seems it may address the issue I am most interested in at the moment — best advice at the treatment decision stage. Would appreciate your comments.
Also I have made contact with our local cancer registry in New South Wales, and they seem a bit optimistic about linking databases and coming up with some data on risks at the treatment decision stage. After our discussions I am a bit wary on success in this, but will let you know down the track if I feel we are getting anywhere.
Finally have signed up as consumer rep on a number of prostate cancer research projects and am looking forward to that.
Tony
It is past time for at least a preliminary publication on the PIVOT trial results in a peer-reviewed paper. Continued delays punctuated by oral presentations can only increase skepticism over Dr. Witt’s controversial results. We (both the medical and patient communities) need and deserve to have access to the details of the PIVOT trial.
I’m just reporting the numbers Tony!
:O)
Tony (Maxwell):
I am sure that Dr. Wilt keeps presenting the results because he is invited to speak about them at conferences. I don’t think he is personally responsible for “re-presenting” these results. On the other hand, this was a relatively straightforward trial, and it is beyond me why the peer-reviewed results are still unpublished.
What I am wondering is whether these data are quite so compelling when one has access to all of the clinical and pathological Gleason scores and other follow-up data. I can imagine that there may be some differences of opinion among the study’s writing group if that is the case. This was a “political” trial from Day 1, and it continues to be one.
I can’t stop imagining that Dr. Wilt is being held hostage somewhere by the radical wing of the AUA, and therefore unable to publish the full results.