Comparative Risk-Adjusted Mortality Outcomes After Primary Surgery, Radiotherapy, or Androgen-Deprivation Therapy for Localized Prostate Cancer

摘要

I read with great interest the article by Gooperberg and co-workers1 studying survival rates in differently treated men with early prostate cancer. In this study, patients who underwent radical prostatectomy had a substantially decreased disease-specific mortality, particularly in the higher-risk groups, compared with those who were selected for radiation therapy or conservative management.1 Unlike Cooperberg et al., I do not consider it unlikely that unmeasured confounding, at least in part, accounted for the observed differences. It is conceivable that patients with a particularly adverse profile within the same risk category might have preferably been referred to external-beam radiotherapy, thus putting this treatment modality at a disadvantage.