In a recendy published study,the results of the Prostate Cancer Intervention versus Observation Trial (PIVOT) trial were compared with that of the Scandinavian Prostate Cancer Group Study Number 4(SPCG-4).The authors concluded that the discrepancy of the mortality rates between both studies may be explained by screenrelated lead time and over-diagnosis.In this comment,some potential biases are discussed and the limited applicability of the results of both randomized trials to healthy candidates for radical prostatectomy is underlined.