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Editor's Correspondence
June 23, 2008

Radiotherapy Dose in the Treatment of Localized Prostate Cancer—Reply

Arch Intern Med. 2008;168(12):1353. doi:10.1001/archinte.168.12.1353

In reply

We recently reported from a population-based study that prostatectomy for localized prostate cancer is associated with better 10-year prostate cancer mortality compared with other therapeutic options including radiotherapy after accounting for therapeutic selection bias.1 Following this publication, 3 letters to the editor questioned the validity of our study, mainly because of its observational nature. Roach refuted our conclusion, arguing that our study lacks data on comorbidities that probably differed according to treatment group and, because of miscoding the cause of death, particularly among elderly patients, the radiotherapy group was overrepresented. To sustain his point, Roach referred to a study from Switzerland based on routine mortality data provided by the Federal Office of Statistics.2 Also, he pointed out that patients treated with radiotherapy with and without hormone therapy had better cause-specific survival (90%) in one clinical trial than what we observed among patients who underwent surgery (83%).3