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October 6, 2004

Natural History of Early Localized Prostate Cancer

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(13):1549-1550. doi:10.1001/jama.292.13.1549-a

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.

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