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October 13, 1993

Treatment Strategies for Prostate Cancer

JAMA. 1993;270(14):1691-1692. doi:10.1001/jama.1993.03510140051021

To the Editor.  —The study by Fleming et al1 is of limited relevance to current prostate cancer management and fails to demonstrate that watchful waiting is as effective as active treatment in men over the age of 65 years. Moreover, it may impart misleading information for treating individual patients.Fleming et al based their estimates of cancer progression rates on a patient population that overrepresented patients most likely to die of other causes, such as elderly men with stage A disease, and underrepresented younger patients with more aggressive tumors. This introduced a bias in favor of watchful waiting.The historical data used for estimates of treatment outcomes do not accurately reflect the current ability to detect prostate cancer early and to treat it effectively. Recent studies have demonstrated a dramatic increase in the detection of early, curable prostate cancer through screening with serum prostate-specific antigen (PSA) measurements.2,3 Fleming