@chippydoo In many/most countries, doctors don't get paid per visit, so you'd need a different explanation for overtreatment. For example, I'm under the care of my family doctor and my cancer centre. The Ontario government pays my doctor a fixed amount per year for having me on her roster, so she makes the same whether I see her 1x or 20x. The hospital where the cancer centre is located gets baseline funding based on the number of people in the area it serves, and my academic oncologist is likely on salary, so he also doesn't get anything extra for more visits. Yet, to a large extent, we're following the same latest/best practices that you'd see at Mayo, etc. for treating prostate cancer.

@surftohealth88 Perhaps the reason they tend to use overall survival rather than PCa-specific is that many cancer treatments increase the risk of dying from other things (e.g. heart disease, diabetes), so they want to see how the benefits and risks balance out. But it definitely distorts things for younger patients: I mean, there's an elevated chance that an 85-year-old will die of *something* in the next 5 years, with or without prostate cancer, so mixing their overall-survival numbers in with those of people diagnosed in their 40s/50s/60s probably skew things quite a bit.