Prostate Cancer Treatment

Your article “The Disease Men Try to Ignore” (Jan. 2) contains some unfortunate errors of fact concerning treatment of prostate cancer with radiation therapy as an alternative to radical prostatectomy. The first is the assertion that “most studies have found a five-year survival rate of about 20%.” Any comparison of survival rates between the two treatment options must be based on patients with similar stages of disease, and when this is done, there is no demonstrable difference in survival between patients treated with surgery or radiation therapy.

Both treatment modalities achieve excellent survival rates for cancers diagnosed while they are confined to the prostate. For example, a recent review of 461 patients who were eligible for surgery but were treated with radiotherapy at the University of Texas M.D. Anderson Cancer Center in Houston showed a six-year survival rate of 83%.

The second serious misstatement in the article is that radiation therapy causes “more side effects than conventional surgery (and) about 3% of patients become incontinent.” Quite the opposite is the case: Indeed, the main attraction of radiotherapy as a treatment option is its negligible risk of urinary incontinence. An analysis of two large series of patients treated at the Massachusetts General Hospital and the M.D. Anderson Cancer Center showed the long-term risk of incontinence after radiotherapy to be only 0.4% (four patients in 1,000).

In an era when early prostate cancer is being diagnosed more frequently with the PSA test, it is important that men understand the true benefits and risks of different treatment options.

LESTER J. PETERS MD

Chairman, American Society

for Therapeutic Radiology and Oncology

Reston, Va.