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To the Editor: The study of survival associated with treatment vs observation of localized prostate cancer by Dr Wong and colleagues¹ suggested that active treatment of elderly men with low- or moderate-risk prostate cancer was associated with a survival benefit. However, 5-year relative survival for localized or regional prostate cancer is 100%.² Therefore, any true survival benefit associated with a treatment would likely begin to first manifest only after 5 years of follow-up. This effect was seen in the recent randomized controlled trial comparing radical prostatectomy with watchful waiting conducted by the Scandinavian Prostate Cancer Group.³ This delay in survival advantage is why it is generally recognized that patients must have a life expectancy of approximately 10 years or more to significantly benefit from any active treatments for prostate cancer.

Figure 1 in Wong et al,¹ however, demonstrated that most of the observed survival differences occurred in the first 5 . . . [Full Text of this Article]

Grace L. Lu-Yao, MPH, PhD
luyaogr@umdnj.edu
Department of Environmental and Community Medicine
Cancer Institute of New Jersey
New Brunswick

Michael J. Barry, MD
Medical Practices Evaluation Center
Massachusetts General Hospital
Boston

Peter C. Albertsen, MD
University of Connecticut Health Center
Farmington

Siu-Long Yao, MD
Cancer Institute of New Jersey
New Brunswick