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July 3, 1996

Defining Clinically Insignificant Prostate Cancer-Reply

Author Affiliations

Mayo Clinic and Mayo Foundation Rochester, Minn
University of Michigan Ann Arbor

JAMA. 1996;276(1):29. doi:10.1001/jama.1996.03540010031019

In Reply.  —The purpose of our study was precisely to evaluate 337 surgically removed cancerous prostate glands by careful histopathologic analysis and to determine how many of these cancers might have become clinically significant over time. Indeed, most patients had potentially clinically significant cancer at the time of surgery, ie, cancers with the potential to develop metastatic disease had the patients not been operated on and had deferred to a conservative program of watchful waiting without treatment. On this basis we concluded that most patients did not undergo unnecessary operations. It was our intent to show that in addition to cancer volume,1 Gleason score, age, and assumed cancer volume doubling time must be included in defining potentially clinically significant cancer.Whether the operations were necessary, defined as successful in preventing clinical disease or death from prostate cancer, is important. This represents 337 patient follow-ups and is an entirely different issue