Intensity-Modulated Radiation Therapy for Prostate Cancer

To the Editor: Mitchell (Oct. 24 issue) 1 highlights the fact that reimbursement drives behavior in physicians who treat prostate cancer. Yet, we are concerned that she may be perpetuating a myth with the statement “. . . evidence suggests that for low-risk disease, the three primary definitive treatments are clinically equivalent when measured in terms of survival.” Although it is true that survival rates associated with these treatments are similar, Mitchell did not point out that that no randomized trial in the era of prostate-specific antigen (PSA) testing has ever shown that definitive treatment of low-risk prostate cancer, as compared with observation, . . .