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May 13, 1998

Detection of Early Prostate Cancer: Serendipitous or Systematic?

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(18):1439-1441. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-18-jac80006

To the Editor.—Dr McNaughton Collins and colleagues1 state, "Randomized trials of the early detection of prostate cancer now under way will help determine whether periodic DRE and PSA screening improve long-term outcomes." This evidence is already available from an earlier series of radical prostatectomies with lymphadenectomy followed for a median of 9.4 years in which pT1-2 disease showed local clinical recurrence (12%), systemic clinical recurrence (12%), and a combined clinical recurrence rate of 20%. This 1990 report2 from the Mayo Clinic involved 261 patients who had wide radical prostatectomy with lymphadenectomy (not nerve-sparing radical prostatectomy in which there are no oncological surgical margins). All of the lesions were pathologically organ confined with 57% with low-grade Gleason disease (grades 2-5) and 43% with high-grade Gleason disease (grades 6-10). There were 3 cancer deaths within 5 years.

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