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Gunnar Aus, MD, PhD; Jonas Hugosson, MD, PhD
Östra Hospital Göteborg, Sweden

JAMA. 1997;278(3):205-206.

	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.

—Dr Johansson and colleagues¹ present data from Örebro County in Sweden with a very favorable 15-year outcome for untreated prostate cancer which, if they are correct, would have tremendous effects on the treatment of localized prostate cancer. However, the study suffers from a bias of unknown nature resulting in a survival twice as high as expected.

Because of good access to health care in Sweden, almost all patients who later die from prostate cancer are diagnosed during their lifetime; ie, they emerge with clinical disease in different stages before death. A high diagnostic activity can be expected to diagnose more patients in early clinical stages while a low diagnostic activity leads to diagnosis of more advanced tumors. When curative treatment is not practiced, the absolute number of patients who die from prostate cancer within 1 geographic area is largely independent of the diagnostic activity.

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