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October 13, 1993

Treatment Strategies for Prostate Cancer

JAMA. 1993;270(14):1692. doi:10.1001/jama.1993.03510140051022

To the Editor.  —This letter is written in regard to the two ghastly articles on the treatment of prostate cancer you published in the May 26, 1993, issue of JAMA.The first article on radical prostatectomy1 purports to show that the recent increase in this procedure has not changed the death rate from this disease and then quotes death rates for the 15 years prior to the increase to substantiate this. The important period will be 15 to 20 years after surgery, not before. The authors do not seem to understand that a sea change has occurred in the diagnosis of prostate cancer because of the advent of the PSA test and the availability of ultrasound-guided biopsy.The article by Fleming et al2 on clinically localized prostate cancer creates a model for treatment based on assumptions, estimates, and assignments, many of which are spurious and all of which