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Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1502 (Published 27 February 2014) Cite this as: BMJ 2014;348:g1502

Re: Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes

The paper unequivocally states ‘there was no discernible difference in treatment effect among men with metastatic disease’ and that ‘radiotherapy might be preferable in men with metastatic disease’.

But the authors have incorrectly labelled the whole of group 4 patients (table 4) as having metastatic disease. Table 4 clearly states that a mere 6% of group 4 patients had distant metastases and only 17% of the same group had loco-regional nodal metastasis [1]. Hence to label the whole of group 4 as having metastatic disease because of presumed micro-metastasis, as alluded by the authors in rapid response , is scientifically incorrect [2].

The authors have clearly put in considerable time and effort to make sense of this huge database but to make unqualified conclusions from presumptions is scientifically untenable. This significant ‘labelling’ error needs a major correction and clarification from the authors.

References
1 Sooriakumaran P, Nyberg T, Akre O, et al. Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes. BMJ 2014;348:g1502.

2 Sooriakumaran P. Re: Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes | BMJ rapid response. http://www.bmj.com/content/348/bmj.g1502/rr/689894 (accessed 20 Mar2014).

Competing interests: No competing interests

21 March 2014
Santhanam SUNDAR
Consultant Oncologist
Kerstie JOHNSON
Nottingham University Hospitals NHS Trust
Nottingham NG5 1PB