Response

Response

“…Because ADT monotherapy is not US Food and Drug Administration approved, we reasoned that initial ADT monotherapy might increase prostate cancer (PCa) deaths. We examined PCaspecific mortality on a country-by-country basis in ERSPC and GOTEBORG and found a correlation between differential ADT usage and PCa deaths (5). We noted the extraordinary disparity in treatment of similar-risk patients between arms, such that in organ-confined disease, 5% of screened patients received ADT vs 13% of control subjects (9).…”

“…The entrenched belief that prostate-specific antigen (PSA) screening saves sufficient lives to offset the extensively documented harms that follow from surgical and other interventions relies entirely on the European Randomized Study of Screening for Prostate Cancer (ERSPC) and GOTEBORG trials (1,2). Despite evidence of serious flaws (3) and alternate interpretations of these data (4,5), this hypothesis is defended at all costs, now by Carlsson, Roobol, Schroder, Hugoson, and Auvinen (6) and earlier by Walsh (7). This belief persists, despite publication of the 80 000 patient Finnish component of ERSPC (8), which revealed no statistically significant benefit from PSA-screening (hazard ratio =0.85; 95% confidence interval = 0.69 to 1.05; P = .10).…”