Prostatectomy and Survival Among Men With Clinically Localized Prostate Cancer

To the Editor.  —In the pooled analysis of radical prostatectomy among 2758 men at 8 major universities in United States and Europe, the authors reported high 10-year diseasespecific survival rates in all tumor grades.¹ However, a closer look at this extensive study permits us to understand the behavior of the tumor and improve the outcome of the most common cancer in men. At 10 years, prostate cancer deaths in grades 1, 2, and 3 were 6%, 20%, and 23% and metastases were seen in 13%, 32%, and 48%, respectively. The data cannot be improved by "watchful waiting." The results suggest patients with grades 2 and 3 disease need postoperative therapy or an alternative treatment approach. The fact that these patients are poor candidates for surveillance is conceded even by its proponents.Results for patients with grade 1 tumors at 10 years are good. Low-grade tumors have a low mitotic index—ie, few mitotic