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January 3, 1996

Survival and Conservative Treatment for Localized Prostate Cancer-Reply

Author Affiliations

University of Connecticut Health Center Farmington

JAMA. 1996;275(1):32. doi:10.1001/jama.1996.03530250035014

In Reply.  —We share the frustration of Drs Swanson, Cowen, Kattan, and Miles concerning the lack of randomized trial data for outcomes following different treatment strategies for localized prostate cancer. In the absence of such data, however, physicians and patients must still make clinical decisions. We designed our study to provide estimates of the maximum lost life expectancy a population of patients can anticipate if they choose conservative management for their localized disease. These data are critical to improving decision-analytic models.1Our study was not designed to evaluate the effectiveness of present-day surgery or radiation treatment. This requires a well-designed randomized trial such as PIVOT,1 currently being conducted by several Veterans Affairs hospitals. Some physicians have criticized this trial on ethical grounds, while others have been reluctant to enroll patients because of their strong bias in favor of aggressive intervention. Our study documents that conservative management can achieve