In Reply We appreciate the Letter from Osinski et al regarding our investigation of the overtreatment of prostate cancer among men with limited longevity. We recognize the uncertainties in risk stratification that limit the application of population-based estimates of life expectancy to an individual patient. Given these concerns, it is important to note that in population-based analyses, there will be a minority of patients that drastically outlive their estimated life expectancy and may derive meaningful benefit from treatment. Similarly, there will be men with longer life expectancy that do not live long enough to benefit from treatment. Yet, treatment decisions should be driven by evidence-based factors predicting when the vast majority of patients will or will not benefit from treatment. from JAMA Internal Medicine Online First https://ift.tt/0UulW1T