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To the Editor: Dr Johansson and colleagues¹ contribute valuable information on the natural history of prostate cancer. However, in my opinion their conclusions are not warranted. The radical treatments available for this disease involve a significant risk of adverse effects and, consequently, often result in a decreased quality of life for patients. Due to widespread use of prostate-specific antigen testing, overdiagnosis and overtreatment have become significant problems^2-3 in both treatment of indolent tumors and in radical treatment.

After 21 years of follow-up, Johansson et al found no disease progression in 60% of patients and only a 16% disease-specific mortality. These findings should be considered good results. I believe that these results support including a watchful waiting group in treatment protocols and entering patients of any age with well-differentiated and even moderately differentiated tumors into these groups.

Jaime Pujadas Oláno, MD
jaipujadas@hotmail.com
Department of Oncology
Hospital Nostra Senyora de Meritxell (Andorra)
Laboratori de Recerca Translacional
Institut Català d’Oncologia
Barcelona, Spain

1. Johansson J-E, Andrén O, Andersson S-O, et al. Natural history of early, localized prostate cancer. JAMA. 2004;291:2713-2719. FREE FULL TEXT 2. Etzioni R, Penson DF, Legler JM, et al. Overdiagnosis due to prostate-specific antigen screening: lessons from US prostate cancer incidence trends. J Natl Cancer Inst. 2002;94:981-990. FREE FULL TEXT 3. Tannock IF. Eradication of a disease: how we cured symptomless prostate cancer. Lancet. 2002;359:1341-1342. FULL TEXT | ISI | PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292:1549.

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