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To the Editor: The randomized clinical trial by Dr Thompson and colleagues¹ of adjuvant postoperative radiotherapy for patients with advanced prostate cancer validated the results of a European study that included more patients but had shorter follow-up.² Because of lower than expected event rates, it was improbable that the primary endpoint of improved metastasis-free survival would be observed unless radiotherapy was particularly effective at preventing spread of residual prostatic fossa cancer, salvage radiotherapy for a detectable prostate-specific antigen level or hormonal therapy did not prevent metastasis, and death from causes other than prostate cancer did not reduce metastasis-free survival.

Salvage radiotherapy improves long-term disease-free survival,³ so it may have contributed to the apparent similarity of metastasis-free survival between observation and adjuvant radiotherapy.¹ In addition, metastasis-free survival was defined as time to metastasis or death from any cause. Metastasis occurred in 35 (17%) of the patients assigned to observation, so 56 . . . [Full Text of this Article]

Thomas M. Pisansky, MD
pisansky.thomas@mayo.edu
Mayo Clinic
Rochester, Minn

Alan Pollack, MD, PhD
Fox Chase Cancer Center
Philadelphia, Pa

Howard M. Sandler, MD
University of Michigan
Ann Arbor

Richard K. Valicenti, MD
Thomas Jefferson University
Philadelphia, Pa

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