Thank you to Ghadjar and Thalmann for their comments to our recent article . Their comments particularly addressed the high-risk group analysis. We appreciate
the opportunity to respond to their comments.
The authors are correct that consecutive reports of certain institutions were reported. The PSA-based results of the patient groups studied in the articles #18, #58 and #59, used here as an example, were reported at years 2006, 2005, and 2010, thus reflecting longer follow-up. No intent at the onset of the study was stated or implied to exclude consecutive and updated analyses. There is a legitimate value to patients in consecutive analyses of patient groups. However, the panel will address this important question in future updates.
The decision regarding article #22 (Potters et al.) to leave the results as external-beam radiotherapy (EBRT) and seeds was based on the author's analysis that the addition of EBRT was not considered an independent predictor. Therefore the symbol was left as combined therapy.
High-dose-rate (HDR) has few reported outcome studies. HDR as monotherapy or combined with EBRT was considered by the panel as HDR. When more articles are available, HDR monotherapy will be separated from combined HDR and EBRT.
The use of androgen-deprivation therapy (ADT) was acknowledged by the panel, but in the stated paper, ADT was not used in all patients and did not have a significant effect on outcome. Therefore the panel chose to record them as EBRT and seeds. In article #44 (Galalae et al.), 33%of patients received ADT. Despite multivariable analysis there was no comment on the effect of
ADT on results. In article #42 (Dattoli et al.), 42% (143/321) of patients received ADT. However, there was NO benefit of ADT on progression-free survival. In article #58 (Merrick et al.) patients were analysed by cohorts, those with ADT and those without, and graphed accordingly. The article #61 (Bittner et al.) cohort was treated with
ADT and analysed. Label corrected to demonstrate. Article #62 (Kollmeier et al.) stated that the addition of hormonal therapy was not a significant factor in outcome (P = 0.27). In article #12 (Burri et al.), 55% (915/1665) of patients received ADT. Univariate analysis did not indicate significant effect of the addition of ADT. The results of these studies on the use of ADT did not show a clear benefit to use of ADT in high-risk disease. The panel chose to analyse them as EBRT and seeds. However, we agree that cohort analysis separating ADT and non-ADT patients will be valuable in future analysis to confirm this observation.
The authors are correct, as it was not clear exactly in article #33 the exact number
of patients receiving <72 Gy. The stated
that the prescribed dose was 70–76 Gy, therefore some patients received <72 Gy, the inclusion minimum. This issue was discussed, but the data point left in place. This will need clarification for future inclusion. For article #56, the authors
were correct that doses of <72 Gy were used and this study will be eliminated from future reviews. The authors are incorrect that article #67 should be reconsidered as there were 53 high-risk patients who received 78 Gy with a median follow-up of 8.7 years, which met the study inclusion criteria and therefore included in the analysis.
The authors felt that several articles
could be included, the Medical Research Council (MRC) RT01, Spahn et al. (2010)
and Freedland et al. (2007) articles. We
agree and these will be included in future updates.
The authors suggested that 15-year data was available from several papers and not charted; however, only one article (#57) reported 15-year data. The 15-year data from the other papers were only in graph form.
We disagree that the paper fails to provide evidence-based prostate cancer treatment comparisons for high-risk disease. The analysis performed in this study was not conducted using randomised studies, as no such studies are available for large scale comparison, so therefore cannot and should not be used as a meta-analysis. However, the study does represent the largest and longest evaluation of PSA-based results
and reflects the current knowledge of comparable results as presented in the literature to date. The observations and changes suggested above do not substantially change the graphical comparisons or conclusions of the article; however, the observations are appreciated and suggested changes will be incorporated in upcoming updates. As this is an on-going effort, further updates will probably resolve cohort differences, particularly in the high-risk group. Interested parties may receive updates of the graphs by e-mailing: email@example.com