Survival and Conservative Treatment for Localized Prostate Cancer

To the Editor.  —The medical community should focus on how the study by Dr Albertsen and colleagues¹ translates into clinical practice, ie, what information it provides for a patient deciding on treatment options today. Our first concern is how applicable these findings are to today's patient with localized prostate cancer. Although a population-based study tends to minimize selection bias, the authors did not study all men with clinically localized disease, only those managed conservatively. In the absence of a reference group (in this case, patients treated with surgery or radiation therapy), the authors chose a general population estimate of life expectancy. They report only the historical survival of selected patients who had opted, for unspecified reasons, for conservative management. Today's clinician and patient, therefore, cannot use this information to compare the expected survival with or without treatment.Second, it is not known if tumors identified in the 1970s are