To the Editor.
—I was disappointed in the study by Dr Albertsen and colleagues.1 Let's start with the central conclusion. Men with prostate cancer with Gleason score 2 to 4 are well served (no loss of years) with no or hormonal treatment. First, half of this group had nonpalpable (ie, classic Al or A2) disease. Also, Gleason score is a major prognostic factor, so it is no surprise that these men are less likely to die of prostate cancer. For stage Al disease, observation has been advocated for some time.2 Within those guidelines, only 20 of the patients with Gleason score 2 to 4 in this current study would have been treated (the number with A2/Bx disease). If 44 patients (total number of Gleason score 2 to 4) isn't already a low enough number of patients on which to make conclusions about potential impact of treatment, 20 certainly
Swanson G. Survival and Conservative Treatment for Localized Prostate Cancer. JAMA. 1996;275(1):31. doi:10.1001/jama.1996.03530250035012