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Jarrod B. Adkison, MD; Mark A. Ritter, MD, PhD

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

We read with interest the recent article by Merglen et al¹ comparing prostate cancer treatments but have concerns regarding the analysis method used and conclusions reached. This retrospective study used the Geneva Cancer Registry and analyzed clinical outcomes of patients treated between 1989 and 1998 for prostate cancer. The authors concluded that radical prostatectomy patients experienced a lower rate of prostate cancer deaths than did those undergoing radiation therapy, observation, or hormonal therapy.

We believe that there are 3 significant limitations of this study by Merglen et al¹ that challenge the authors' conclusions.

1. The article fails to define its main end point, prostate cancer–specific death. Retrospectively determining the cause of death is a notoriously inaccurate undertaking. A common error, for example, would be to accept a death certificate that attributes death to prostate cancer without having accompanying documentation of metastatic disease.
   
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