© The Author 2006. Published by Oxford University Press.
CORRESPONDENCE |
RESPONSE: Re: Incidence of Initial Local Therapy Among Men With Lower-Risk Prostate Cancer in the United States
Affiliations of authors: Departments of Urology (DCM, BKH, JEM, JTW), Internal Medicine (SBG), Epidemiology (SBG), and Human Genetics (SBG), University of Michigan, Ann Arbor, MI
Correspondence to: John T. Wei, MD, MS, Department of Urology, Taubman Health Care Center, University of Michigan Health System, 1500 East Medical Center Dr., Ann Arbor, MI 48109-0330 (e-mail: jtwei{at}med.umich.edu).
We agree with the concerns raised by Dr Vikram. First, we acknowledge that our data are insufficient to draw inference regarding the appropriateness of care for individual patients. Rather, our study estimated levels of treatment among patients who were, on average, either at relatively low risk of dying from conservatively managed prostate cancer over the next 20 years (1) or less likely to experience an overall survival benefit from aggressive local therapy (2). Second, we agree that estimates of life expectancy should play an important role in treatment decisions for men with prostate cancer. Unfortunately, life expectancy cannot be assessed from Surveillance, Epidemiology, and End Results data; moreover, accurately estimating life expectancy remains a substantial challenge for many clinicians (3,4). Third, we concur that insufficient data regarding patterns of hormonal therapy limit our study and that primary androgen deprivation therapy can have substantial financial and physical costs. We did not set out to determine who should be treated for early-stage prostate cancer; rather, we hoped to stimulate further dialogue and research in this important area.
REFERENCES
(1) Albertsen PC, Hanley JA, Fine J. 20-year outcomes following conservative management of clinically localized prostate cancer [see comment]. JAMA 2005;293:2095–101.
(2) Bill-Axelson A, Holmberg L, Ruutu M, Haggman M, Andersson SO, Bratell S, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. New Engl J Med 2005;352:1977–84.
(3) Cowen ME, Halasyamani LK, Kattan MW. Predicting life expectancy in men with clinically localized prostate cancer. J Urol 2006;175:99.[CrossRef][Web of Science][Medline]
(4) Kistler CE, Lewis CL, Amick HR, Bynum DL, Walter LC, Watson LC. Older adults' beliefs about physician-estimated life expectancy: a cross-sectional survey. BMC Fam Pract 2006;7:9.[CrossRef][Medline]
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