Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
To the Editor: In their study of the natural
history of prostate cancer, Dr Johansson and colleagues1 concluded
that their findings support early radical treatment of localized prostate
cancer. An important limitation of this study is that most of the patients
were diagnosed by cytological evaluation of a fine-needle prostate aspirate.2 The Gleason histological grading system is the most
common method for grading prostate tumors, and we believe it to be a more
accurate predictor of prognosis. Using this system, Albertson et al3,4 were able to show that the long-term
outcome following conservative therapy was significantly different for tumors
with Gleason scores of 5 vs Gleason scores of 6, and for Gleason scores of
6 vs Gleason scores of 7. Patients with tumors with these scores would have
been combined in the moderately differentiated tumor group in the Johansson
study. Because such a division into 3 subgroups is not possible in this study,
combining all moderately differentiated cancers is not justified.
Osborn JR, Chodak GW. Natural History of Early Localized Prostate Cancer. JAMA. 2004;292(13):1549-1550. doi:10.1001/jama.292.13.1549-a