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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

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

Patients selecting radical prostatectomy are likely to be more healthy and be harbouring earlier tumour stages. It is conceivable that even within the same risk category the worst cases were assigned to external beam radiotherapy due to selection and self-selection. Thus, beside overt imbalance in the risk distribution between surgery and radiotherapy [1], there were probably further hidden biases putting surgery at an advantage [2]. These biases may not be eliminated completely even by advanced statistics. Only randomized trials are able to prove superiority of any treatment option for early prostate cancer.

1 Sooriakumaran P, Nyberg T, Akre O, Haendler L, Heus I, Olsson M, Carlsson S, Roobol MJ, Steineck G, Wiklund P. Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes. BMJ 2014;348:g1502.

2 Hoffman RM, Koyama T, Fan KH, Albertsen PC, Barry MJ, Goodman M, Hamilton AS, Potosky AL, Stanford JL, Stroup AM, Penson DF. Mortality after radical prostatectomy or external beam radiotherapy for localized prostate cancer. J Natl Cancer Inst 2013;105:711-8.

Competing interests: No competing interests

10 April 2014
Michael Froehner
Urologic Surgeon
Manfred P. Wirth
University Hospital Carl Gustav Carus, Technische Universität Dresden
Fetscherstrasse 74, D-01307 Dresden