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To the Editor: I have concerns about the mortality measures used in the study of survival in elderly men with prostate cancer by Dr Wong and colleagues.¹ The difference in the death rate from prostate cancer in these 2 groups was 0.6% (1.9% in the treatment group vs 2.5% in the observation group). Men aged 70 years and older were expected to have a 30-day perioperative mortality rate of 0.66%,² which is not included in the previously stated rates. Adding this 0.66% to the 1.9% prostate cancer-specific mortality in the treated group gives a mortality of 2.56%, which is the same as in the observation group. One fourth of the deaths in this surgically treated group would be expected to occur in the first 30 days. This raises the question of the benefit of surgery for men aged 70 years and older.

Financial Disclosures: None reported.

George A. Mark, MD
georgeamark@yahoo.com
Department of Internal Medicine
Elkhart General Hospital
Elkhart, Ind

1. Wong YN, Mitra N, Hudes G, et al. Survival associated with treatment vs observation of localized prostate cancer in elderly men. JAMA. 2006;296:2683-2693. FREE FULL TEXT 2. Alibhai SM, Leach M, Tomlinson G, et al. 30-Day mortality and major complications after radical prostatectomy: influence of age and comorbidity. J Natl Cancer Inst. 2005;97:1525-1532. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;297:1652.