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Editor's Correspondence
July 24, 2006

No One Dies From Prostate Cancer?

Arch Intern Med. 2006;166(14):1525. doi:10.1001/archinte.166.14.1525-c

The study by Concato et al1 identified 501 men who received a diagnosis of prostate cancer between 1991 and 1995 and died by 1999. These dates are more than 10 years ago; medicine has changed a lot in a 10-year period. Practice management for heart disease, stroke, diabetes, hyperlipidemia, and prevention of these issues has improved outcomes as reported in numerous landmark studies. Based on these 10-year-old data, the authors concluded that routine prostate cancer screening of asymptomatic men should not be endorsed because no reduction in mortality was found in their study. As a practicing physician whose focus is on end-of-life care and geriatrics, I see patients dying of their prostate cancer with bone metastasis who were given their diagnosis after their study inclusion period. It appears that changes in medical management of other illness (eg, heart disease and stroke prevention) advanced during these past 10 years introduce the question of validity into their study and conclusion. How do we know that current (not 10 years ago) screening for prostate cancer would not curb mortality? In our age of rapid information dissemination via the internet and other communication means, should we not also update our clinical studies databases to reflect more relevant times? Their antiquated study population makes me question the validity of their conclusion.

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