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To the Editor: Dr D'Amico and colleagues¹ reported that patients at intermediate and high risk of prostate-specific antigen (PSA) failure had better PSA outcomes if they were treated with radiation therapy (RT) and androgen suppression therapy (AST) vs RT alone. However, there are several serious problems with this study that limit its validity.

First, without sufficient follow-up time, the American Society for Therapeutic Radiology and Oncology (ASTRO) Consensus Panel definition of PSA failure markedly underestimates the true biochemical failure rate (due to backdating) unless the follow-up interval approaches or exceeds the time point chosen for analysis.^2-3 This misrepresentation of the actual biochemical failure rate due to short follow-up time can range from 15% to 30%, which is well within the range of the perceived benefit of AST that D'Amico et al reported. While they correctly note that the statistically significant shorter follow-up (2 to 6 months) in the intermediate- and . . . [Full Text of this Article]

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RELATED ARTICLE

Biochemical Outcome Following External Beam Radiation Therapy With or Without Androgen Suppression Therapy for Clinically Localized Prostate Cancer
Anthony V. D'Amico, Delray Schultz, Marian Loffredo, Raymond Dugal, Mark Hurwitz, Irving Kaplan, Clair J. Beard, Andrew A. Renshaw, and Philip W. Kantoff
JAMA. 2000;284(10):1280-1283.
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