© The Author 2006. Published by Oxford University Press.
CORRESPONDENCE |
Re: Incidence of Initial Local Therapy Among Men With Lower-Risk Prostate Cancer in the United States
Correspondence to: Bhadrasain Vikram, MD, Clinical Radiation Oncology Branch, National Cancer Institute, 6130 Executive Blvd., Suite 6002, Rockville, MD 20892-7440 (e-mail: vikramb{at}mail.nih.gov).
Miller et al. (1) found that among men with lower-risk prostate cancer, 55% may have been overtreated (most of them by radiation therapy), whereas 45% underwent "appropriate" expectant management or androgen deprivation therapy. It is indeed noteworthy that so many of the lower-risk cases were treated by curative therapy rather than expectant management or androgen deprivation therapy.
However, appropriateness depends more upon the remaining life expectancy of the patient than his chronologic age. For example, curative therapy may be more appropriate for a 75-year-old man who has a long life expectancy than for a 60-year-old man who has a short life expectancy. Before concluding that overtreatment was rampant, therefore, Miller et al. should have examined a sample of the subjects to determine whether or not chronologic age was indeed a good surrogate for estimated life expectancy in this particular population. If the patients selected by physicians for curative therapy had much longer life expectancies than those selected for expectant management, then each treatment was probably quite appropriate.
Finally, expectant management, as described by Miller et al., included observation as well as surgical or medical castration, which have enormously different physical and financial repercussions. In determining "appropriateness", it is therefore important to know something about the relative frequencies of these various kinds of expectant management as well.
NOTES
The views expressed herein are those of the author and do not necessarily represent the views of the National Institutes of Health or the US Government.
REFERENCES
(1) Miller DC, Gruber SB, Hollenbeck BK, Montie JE, Wei JT. Incidence of initial local therapy among men with lower-risk prostate cancer in the United States. J Natl Cancer Inst 2006;98:1134–41.
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J Natl Cancer Inst 2006 98: 1134-1141.
J Natl Cancer Inst 2006 98: 1826.
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