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To the Editor: Dr Wong and colleagues¹ report a survival advantage in elderly men with low- and intermediate-risk prostate cancer who undergo active treatment compared with those who are observed. I believe that these results should be interpreted with caution.

In the active treatment cohort, 42% of the men underwent prostatectomy, the only group in which pathologic stage was available. Since the SEER database records the pathologic stage when available, these men were classified as low- or intermediate-risk based on pathologic staging. Similarly, these patients were classified as low- or intermediate-risk based on pathologic Gleason score. Nonsurgical patients were classified by clinical stage and biopsy Gleason score.

Pathologic upstaging and upgrading are common events at prostatectomy. During the early time period of the study by Wong et al, it was reported that 40% of clinical stage T1c (prostate-specific antigen-detected) cancers and 57% of clinical stage T2 (palpable) tumors were upstaged . . . [Full Text of this Article]

Michael P. Porter, MD, MS
mporter@u.washington.edu
Department of Urology
University of Washington
Seattle

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