Authors: Timothy J Daskivich Karim Chamie
Publish Date: 2012/07/11
Volume: 27, Issue: 10, Pages: 1241-1241
Abstract
The Authors reply While a minority of men with severe manifestations of certain comorbid diseases will have favorable outcomes our data suggest that the majority of these men do very poorly Since there is a spectrum of disease severity within a given disease state — even for the most morbid diseases — men who are preselected for good health ie radical prostatectomy candidates will inevitably exhibit less severe manifestations of disease Therefore the survival estimates associated with comorbidity in a radical prostatectomy cohort will appear inflated compared with those in a broader population of men with newly diagnosed disease However we feel that the latter scenario more accurately models the intended clinical question How do we quantify the average risk of mortality associated with a given comorbidity for a man with newly diagnosed prostate cancer While we certainly agree that clinical context may alter prognosis estimates associated with a given disease state we strongly feel that patients and their doctors should be well informed of the typical prognosis associated with their preexisting comorbidities prior to subjective adjustment These estimates are most accurate when considered in a cohort of men with newly diagnosed disease rather than those undergoing definitive treatment
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