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Survival (or Selection) of the Fittest?

Mark S. Litwin, MD, MPH; David C. Miller, MD, MPH

JAMA. 2006;296:2733-2734.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Recent declines in cause-specific mortality rates among men with prostate cancer suggest that early diagnosis and treatment for localized tumors may improve survival.^1-2 In particular, in a randomized controlled trial from Scandinavia, Bill-Axelson et al³ demonstrated that patients with clinically detected, early stage prostate cancers who were assigned to radical prostatectomy had better survival than those assigned to watchful waiting.³ An important caveat is that the survival benefits of prostatectomy were concentrated among men younger than 65 years.³ Given that the frequently indolent nature of prostate cancer in older men,^4-5 this finding begets clinical uncertainty regarding the role of initial local therapy in this population.

In this issue of JAMA, Wong and colleagues⁶ address this important gap in current knowledge with data from a well-designed and well-executed observational study. Specifically, the authors used population-based, linked data from the National . . . [Full Text of this Article]

Author Affiliations: Department of Urology, David Geffen School of Medicine (Drs Litwin and Miller); Department of Health Services, School of Public Health (Dr Litwin); Jonsson Comprehensive Cancer Center (Drs Litwin and Miller); University of California, Los Angeles.

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