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November 8, 1995

A 72-Year-Old Man With Localized Prostate Cancer

JAMA. 1995;274(18):1426. doi:10.1001/jama.1995.03530180020018

To the Editor.  —Dr Albertsen's article1 arrives at a defensible conclusion for a 72-year-old man with newly diagnosed prostate cancer. However, watchful waiting cannot be supported as a form of delayed therapy. There are no published studies that describe the outcome of delayed therapy. Prostate-specific antigen (PSA) trends have been described in populations of men, but these trends have not been demonstrated to be an indicator of progression and need for therapy in individual patients.2 Prostate-specific antigen has been approved as a diagnostic tool for prostate cancer, not as a predictor of cancer behavior. The notion of delayed therapy disguised as watchful waiting becomes more troubling when Albertsen suggests the patient undoubtedly doesn't need therapy because "Mr S has a relatively modest tumor burden" and that men with a PSA of less than 10 ng/mL have "only a 43% chance of extracapsular extension." These statements are incongruous. If

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