[Skip to Content]
[Skip to Content Landing]
October 13, 1993

Treatment Strategies for Prostate Cancer-Reply

Author Affiliations

Oregon Health Sciences University Portland

JAMA. 1993;270(14):1693. doi:10.1001/jama.1993.03510140051025

In Reply.  —The respondents seem to share the conviction that earlier detection and treatment of prostate cancer will reduce mortality. Unfortunately, this view is not supported by available data. Screening will undoubtedly detect tumors too small to be detected by other means. Inevitably, this process leads to apparent improvements in survival from the time of diagnosis that have nothing to do with therapeutic interventions and their effectiveness.1Drs Catalona and Switzer miss the main point of our article. We did not intend to prove that watchful waiting was more effective than invasive treatment, nor did we assume that radiation was better than surgery. We built a decision model with optimistic assumptions, biased in favor of invasive treatments, to evaluate whether either treatment might result in better outcomes than watchful waiting. We framed our article to ask a question: From the patient's point of view, is the potential for benefit