Letters Section Editor: Robert M. Golub, MD, Senior Editor.
To the Editor: The study of survival associated with treatment vs observation of localized prostate cancer by Dr Wong and colleagues1 suggested that active treatment of elderly men with low- or moderate-risk prostate cancer was associated with a survival benefit. However, 5-year relative survival for localized or regional prostate cancer is 100%.2 Therefore, any true survival benefit associated with a treatment would likely begin to first manifest only after 5 years of follow-up. This effect was seen in the recent randomized controlled trial comparing radical prostatectomy with watchful waiting conducted by the Scandinavian Prostate Cancer Group.3 This delay in survival advantage is why it is generally recognized that patients must have a life expectancy of approximately 10 years or more to significantly benefit from any active treatments for prostate cancer.
Lu-Yao GL, Barry MJ, Albertsen PC, Yao S. Outcomes of Treatment vs Observation of Localized Prostate Cancer in Elderly Men. JAMA. 2007;297(15):1651-1653. doi:10.1001/jama.297.15.1651-a