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October 25, 2000

Do Increased 5-Year Survival Rates in Prostate Cancer Indicate Better Outcomes?—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(16):2053-2055. doi:10.1001/jama.284.16.2053

In Reply: Mr Donnelly argues that prostate cancer screening is effective. Given all the men who have been exposed to multiple diagnostic and therapeutic procedures, we certainly hope this is true. Unfortunately, no one knows.

What we do know is this: there is no cancer with a more dramatic change in 5-year survival than prostate cancer, for which survival rates have increased from about 40% in the 1950s to about 95% currently. While it is tempting to conclude that medical treatment has made major advances, the fact is that prostate cancer has about the most stable mortality rate (21.6 per 100,000 in 1950, 21.0 per 100,000 in 1973, and 22.5 per 100,000 in 1997) of all major cancers.1 Prostate cancer exemplifies our basic point: changes in 5-year survival overstate progress against cancer. Using 5-year survival to make judgments about screening will always lead to the conclusion that screening is effective.

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