EURURO Vol. 72 No. 6

887 1030

positive responses to two items from the EPIC instrument).
How do we explain these two almost diametrically opposed
findings? Superior outcomes at high-volume centers may be
due to: (1) a better surgical technique; (2) better selection of
patients; (3) differences in study methodology; or (4) a
combination of these factors. Regardless of the cause of the
differences, it is clear that the average urologist who does not
collect his or her own outcomes data must counsel patients
with data from studies like the systematic review by [2_TD$DIFF]Lardas
and colleagues as opposed to those fromthe high-volume,
single-center series. The findings presented in the systematic
review represent the ‘‘average’’ outcomes delivered by the
‘‘average’’ urologist or radiation oncologist, and therefore
must be sharedwith the ‘‘average’’ patient. Given that studies
in the [2_TD$DIFF]Lardas et al report imply thatmost urologists cannot
achieve the outcomes reported in the high-volume, single-
center series, it would be wrong to quote the superior
outcomes seen in these single-center reports to patients
(unless, of course, you happen to be a surgeon at one of the
high-volume centers that published its outcomes).
Building on the last point, this systematic review
underscores the need to use these data for developing
new and standardized ways to help patients make truly
informed decisions around treatment for localized prostate
cancer. When one considers the heterogeneity of the
literature on QOL outcomes following treatment for
localized prostate cancer, it becomes abundantly clear
how difficult it is to discuss the risks and benefits of each
treatment in the relatively short time afforded during a
regular office visit. We must identify novel ways to
disseminate the information presented in this study in a
way that patients can understand and use. Rather than try
to push the envelope with minor technical changes in
surgery or radiation that are likely, at best, to result in only
small improvements in QOL outcomes, it is time we devoted
our efforts to identifying better ways to help patients
understand what will really happen to them after treatment
so that they can make the most informed decision possible.
Conflicts of interest: The author has nothing to disclose.
References
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after primary treatment for clinically localised prostate cancer: a
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[2] Resnick MJ, Koyama T, Fan K-H, et al. Long-term functional out-
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[3] Barocas DA, Alvarez J, Resnick MJ, et al. Association between
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[4] Donovan JL, Hamdy FC, Lane JA, et al. Patient-reported outcomes
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