I read with interest the above “Comment” by Dr Gnanapragasam in the August issue of the Journal . While I applaud his efforts at suggesting improvements to the criteria by which a decision is made to manage a patient with prostate cancer on an active surveillance program I feel he distracts from the clear, simple and important message of the PIVOT trial . That message is that if, using the D’Amico criteria , a patient is classified as being in a low risk prostate cancer group then prostate-cancer mortality will not be significantly lower if that patient has a radical prostatectomy compared to that patient being on an active surveillance program. The D’Amico criteria may need updating or improvement but that does not change the basic and clinically important message of the PIVOT trial.
Derek J Byrne MD FRCSI
Consultant Urological Surgeon, NHS Tayside
- Gnanapragasam VJ. To treat or not to treat: is the way forward clearer in low-risk prostate cancer. BJUI 2013; 112: 285-287.
- Wilt TJ, Brawer MK, Jones KM et al. Prostate Cancer Intervention versus Observation Trial (PIVOT) Study Group. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med 2012; 367: 203-13.
- D’Amico AV, Whittingham R, Malkowicz SB et al. Biochemical outcome after radical prostatectomy, external beam radiotherapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998; 280: 969-74.