September 24, 1997

Predicting Pathological Stage of Localized Prostate Cancer-Reply

Author Affiliations

The Johns Hopkins Hospital Baltimore, Md
University of Michigan School of Medicine Ann Arbor
Baylor College of Medicine Houston, Tex
Merck Research Laboratories Rahway, NJ

JAMA. 1997;278(12):981-982. doi:10.1001/jama.1997.03550120041028

In Reply.  —Dr Naitoh and colleagues criticized our analysis based on poor correlation between their own clinical and pathological data compared with data we reported for 4133 patients treated at 3 different institutions. In summary, they found that men with tumors having Gleason scores of 6 and 7, clinical stage of T2b, and PSA levels between 4 and 10 ng/mL had a higher likelihood of having organ-confined disease in their series than was reported by the nomograms presented in our work. They report rates of 70% (Gleason score 6) and 50% (Gleason score 7) of organ-confined disease for men within this subgroup, compared with the rate of 38% and 22% for similar patients in our study.We agree with Naitoh and colleagues that patients with capsular penetration can in fact be cured by radical prostatectomy; however, the probability of cure is less than for those men with organ-confined disease. Therefore, predicting organ-confined