Few patients with prostate cancer are willing to be randomised to treatment

BMJ 1999;318:1556 ( 5 June )

Letters

Few patients with prostate cancer are willing to be randomised to treatment

The first 150 words of the full text of this article appear below.

EDITOR $---$ No one would deny the need for controlled prospective trials to determine best management in serious conditions suchas prostate cancer. But to adopt a nihilistic approach towardsavailable treatments because such data do not exist is to turnback the clock of progress. Proponents of evidence based medicinemay claim that there is no evidence that radical prostatectomyis the treatment of choice for early prostate cancer, but thereis no evidence that it isnot.

Willis's suggestion that patients should "only have access to a treatment by agreeing to abide by the protocol, which wouldinclude randomisation," is arrogant, and insulting to patientsand doctors.¹ Men with a life expectancy of 10-25 years whodevelop prostate cancer will not allow themselves to be randomisedto a "watchful waiting group" (waiting for what? $---$ disease progression?metastases?), as the early ending of the MRC PRO6 trialshowed.

Stepping Hill . . . [Full text of this article]