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Treatment Outcome Comparisons - Informative High Quality Studies Missing (March 2008)
The phrase "putative
equivalence" was used in the previous article referring to the
comparison of outcomes among primary treatment for localized prostate
cancer, since, as it turns out, solid head-to-head data are very hard -
if not impossible to come by. The Agency for Healthcare and Quality
commissioned a review (Wilt T, Ann of Intern Med, Feb., 2008)
which identified 18 candidates for high-quality, randomized, controlled
trials published as of mid-September 2007. The authors found
"insufficient data to compare the efficacy and safety of available
treatments." The search encompassed 14,045 relevant articles. Only three
direct comparisons among major treatments were found, and none of the 18
trials focused on PSA-detected cancer, despite the current preponderance
of this route to diagnosis. Most studies did not report disease-specific
mortality. The report concluded that "The paucity of clinically
important information from high-quality randomized trials remains the
main barrier to well-informed decision making."
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