Radical Surgery or Watchful Waiting in Prostate Cancer

To the Editor: Bill-Axelson et al. (Dec. 13 issue) 1 report that at a median follow-up of 23.6 years, radical prostatectomy prolonged overall survival among men with localized prostate cancer, as compared with “watchful waiting.” Using a Cox proportional-hazards model, the investigators calculated a hazard ratio for death for prostatectomy versus watchful waiting of 0.55 (95% confidence interval [CI], 0.41 to 0.74]), which they reported as a relative risk. At 23 years, they found that prostatectomy extended the men’s lives by a mean of 2.9 years. However, the 23-year residual mean survival time was defined as the average remaining survival time . . .