To the Editor: Chodak et al. (Jan. 27 issue)1 conclude that conservative management is an appropriate choice for some patients with clinically localized prostate cancer — that is, those with a life expectancy of 10 years or less. However, because they did not detect a statistically significant bias due to the overrepresentation of men with low-grade, low-stage tumors in their patient population, Chodak et al. imply that conservative management is appropriate for all patients with localized prostate cancer. In their sample of patients, the risk ratios for mortality due to prostate cancer increased proportionately, albeit not always significantly, with tumor.
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