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William J. Catalona, MD
Washington University St Louis, Mo

JAMA. 1992;268(22):3198.

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

To the Editor.

—The study by Johansson et al¹ is of limited relevance because their selection criteria resulted in a study group that is not representative of the patient population with early prostate cancer. Their study group included an inordinately high proportion of men over the age of 75 years, most of whom had low-grade tumors too small to be detected on rectal examination. Nearly half of the tumors were discovered at the time of an operation for presumed benign hyperplasia. Because such tumors progress slowly and most patients were elderly to begin with, it is not surprising that most patients died of other causes. The patient selection process was a self-fulfilling prophesy.

During the first 2 years of their study, only patients with grade 1 tumors were accepted for the untreated group, which enriched the group with low-grade tumors. During the last 5 years, some patients under the . . . [Full Text PDF of this Article]

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