In Reply: As Dr Vikram notes, the 9-Gy–higher radiation dose in PROG 9509 has not produced a survival benefit despite halving biochemical, or prostate-specific antigen, progression.1,2 Given the association between progression-free survival and overall survival, an overall survival benefit from the higher dose may emerge. However, such an advantage will be delayed by the relatively indolent natural history of prostate cancer and attenuated by competing mortality, given the 76-year median age of surveyed men. Both effects were seen in the Scandinavian randomized trial of surgery vs observation for early prostate cancer.3 We do believe that finding no outcome differences between study groups using a sensitive, treatment-specific survey instrument is stronger evidence of similar long-term outcomes than the comment that patients “stopped complaining” suggests.
Talcott JA, Zietman AL. Conventional and High-Dose Radiation in Treating Early Prostate Cancer—Reply. JAMA. 2010;304(2):155-156. doi:10.1001/jama.2010.928