Don't throw the baby out with the bath water

Abstract

We read with interest the recently published article "Survival rates with external beam radiation therapy in newly diagnosed elderly metastatic prostate cancer patients." 1 The authors conducted a SEER database review and concluded that external beam radiotherapy (EBRT) does not affect survival in an elderly population of patients with metastatic prostate cancer. We agree that it is likely that not all elderly patients with metastatic disease benefit from local radiotherapy to the prostate. However, we are concerned that a significant subcohort that derives substantial benefit from local radiotherapy is lost in this large database study that is severely limited by a lack of granularity and randomization.