Conditional Survival in Prostate Cancer in the Nordic Countries Elucidates the Timing of Improvements

Round 1

Reviewer 1 Report

 Zitricky et al., has shown survival kinetics of PC patients in the Nordic countries and how PSA testing changed the mortality rate of these patients. This is an interesting study and authors have collected a unique dataset from NORDCAN over the period of 50 years. The relatively large sample size (for this kind of data) is also a strength. Having said that while prostate cancer mortality rates have declined since the advent of PSA testing, it is uncertain what proportion of this is due to PSA screening alone. Another aspect is that PSA may also be elevated in the absence of PC in males with ongoing benign conditions. Can this be accounted for?

The paper is generally well written and structured, however a more detailed introduction on Prostate cancer and what and how PSA testing is done would make the manuscript easily understandable for a wider audience. I like how authors have written the discussion which explains their results precisely. Limitations of the study has also been addressed correctly.

Author Response

We are thankful for the reviewer bringing up the point about benign prostate disease. We added related text to l. 61-70, including some references-  

Reviewer 2 Report

The authors deserve congratulations for their work. The topic is interesting, and the manuscript is well-written and easily readable. The use of conditional survival represents a methodology that has been widely described and validated. I suggest citing some studies that have utilized this methodology (e.g., PMID: 37141747; PMID: 32107785) to strengthen the robustness of the methodology. However, a minor revision is required.

Author Response

We thank the reviewer for his positive comments and pointing out other clinical applications of conditional survival. We added the suggested references, l. 106-8.