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Outcomes of Treatment vs Observation of Localized Prostate Cancer in Elderly Men—Reply
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In Reply: The letters by Dr Lu-Yao and colleagues, Dr Scholz and colleagues, and Dr Mark raise the important issue that prostate cancer-specific mortality was low in both groups, and that the absolute difference (0.6%) may not outweigh the potential long-term adverse effects caused by the treatment. However, we believe that the assessment of prostate cancer-specific mortality has limitations and should be interpreted with caution. SEER reports cause of death information derived from state death certificate data, which have poor correlation with autopsy findings.1-2 The high prevalence of comorbidities in this elderly patient population can make attribution of cause of death challenging. For example, initial treatment course may influence the cause of death that is ultimately listed on death certificates,3 and this "cause of death attribution bias" may have an effect on prostate cancer-specific mortality.4 We believe that since overall survival (our primary endpoint) is more consistently reported, the data . . . [Full Text of this Article]
Yu-Ning Wong, MD, MSCE
y_wong@fccc.edu
Division of Population Science
Fox Chase Cancer Center
Philadelphia, Pa
Nandita Mitra, PhD
Department of Biostatistics and Epidemiology
University of Pennsylvania
Philadelphia
Gary Hudes, MD
Division of Medical Science
Fox Chase Cancer Center
J. Sanford Schwartz, MD
Division of General Internal Medicine
University of Pennsylvania
Fei Wan, MD;
Chantal Montagnet, MPhil;
Katrina Armstrong, MD, MSCE
Division of General Internal Medicine
University of Pennsylvania
RELATED LETTERS
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Outcomes of Treatment vs Observation of Localized Prostate Cancer in Elderly Men
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RELATED ARTICLE
Survival Associated With Treatment vs Observation of Localized Prostate Cancer in Elderly Men
Yu-Ning Wong, Nandita Mitra, Gary Hudes, Russell Localio, J. Sanford Schwartz, Fei Wan, Chantal Montagnet, and Katrina Armstrong
JAMA. 2006;296(22):2683-2693.
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