Author reply

Abstract

Schulz and Kagan underscore the dilemma faced by physicians and patients alike regarding the treatment of localized prostate carcinoma. Clinicians have the impression, supported to some degree by the report by Holmberg et al.,1 that some patients benefit from radical surgery. However, clinicians are unable to identify unambiguously those patients who will derive a survival benefit from prostatectomy. We are encouraged that the Prostate Cancer Intervention Versus Observation Trial (PIVOT) closed to accrual in 2002 and eagerly await the results of that randomized trial (available from URL: http://www.va.gov/PIVOT/ [accessed April 2004]). In the interim, clinicians continue to make their best guess regarding the benefits of surgery and the likelihood of recurrence. Valuable assistance comes from predictive nomograms that are derived from longitudinal observations.2 These nomograms are available to the clinical care community (available from URL: http://www.mskcc.org/mskcc/html/10088.cfm [accessed April 2004]). The main motivation for publishing our report3 was to provide follow-up data for community-based urologic practices for comparison with several published trials from university-based practices. We believed these data were important because to our knowledge there are no formal national pattern of care studies for radical prostatectomy, although a recent report suggests that postoperative complication rates are inversely related to surgical volume.4 Tissue samples from the cohort described in our article have been transferred to a tissue microarray for use in the survival analysis of potential prognostic markers. We welcome collaborators who wish to access this resource and hope that until definitive randomized data concerning the survival benefits of prostatectomy are forthcoming, we help refine prognostic tools further to assist in the decision making of clinicians and patients.