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To the Editor: Dr Wong and colleagues¹ report a statistically significant reduction in overall mortality with immediate surgery or radiation for low- to intermediate-risk prostate cancer. The absolute difference in overall mortality between the men receiving immediate treatment compared with no treatment was large (24% in the treatment group and 37% in the observation group). However, we question the validity of using overall mortality as an endpoint for measuring the anticancer treatment efficacy when the difference in prostate cancer-specific mortality over the 12-year study period was small (612 of 32 022 [1.9%] in the treatment group vs 314 of 12 608 [2.5%] in the observation group).

Contemporary treatment for localized prostate cancer is associated with a significant risk of long-term morbidity, including a 30% to 70% chance of erectile dysfunction and a 10% to 15% risk of incontinence.² In this context, the clinical significance of a 0.6% absolute difference in cancer-specific survival . . . [Full Text of this Article]

Mark C. Scholz, MD
mark@prostateoncology.com

Richard Y. Lam, MD
Prostate Oncology Specialists, Inc
Marina del Rey, Calif

Laurence Klotz, MD, FRCSC
University of Toronto
Ontario

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