LAUSR

T here are emerging data supporting the idea that radical prostatectomy benefits men with early, lethal prostate cancer [1]. But is it ready for prime time? In the February issue of BJUI, Jang et al. [2] report their 11-year series of men with synchronous skeletal oligometastatic prostate cancer treated with radical prostatectomy. Surprisingly, their data go as far back as 2005, when very little information supported this treatment strategy. It is difficult therefore to be certain what informed the treatment choice between surgery alone, surgery preceded by systemic therapy and systemic therapy alone, all approaches reported on in their analysis. The lack of statistically significant differences in many patient characteristics among these treatment cohorts can be explained by low numbers of 22, 16 and 41 in the respective cohorts. The non-statistically significant differences in presenting PSA, comorbidity burden, and clinical Tand N-stages (and unknown differences in numbers of skeletal metastases), as well as the statistically significantly higher age in the patients receiving systemic therapy alone would probably have resulted in confounding by indication (selection bias) with consequent overestimates of surgical benefit. Hence, univariable and multivariable analyses in their report favouring surgery in progression-free and cancer-specific survival should be considered hypothesis-generating rather than hypothesistesting, and certainly are not hypothesis-proving.