According to Smith et al,1 almost two thirds of 977 men with nonpalpable early-stage prostate cancer detected by prostate-specific antigen (PSA) testing had clinically significant cancers. This is an extraordinarily high figure. They list 4 high-risk groups. The first 2 groups had very high PSA levels, and a large percentage of the multiple biopsy specimens were positive for cancer. The bulk of patients are in groups 3 and 4. Group 3 comprised patients 70 years or younger with Gleason scores of 7. Group 4 comprised patients 65 years or younger with Gleason scores of 6. Both groups had a low percentage of positive biopsy findings, and more than 90% had PSA levels of 10 or less. One would think these would likely not be high-risk groups. The argument for being high risk depends apparently on the assertion that Gleason scores of 7 have a 7% annual risk of death from prostate cancer and a 66% lifetime risk of dying from the disease. The comparable figures indicated for a Gleason score of 6 were 4.5% annual risk of death and at least a 50% likelihood of prostate cancer death.
Louria DB. The Likelihood That PSA Detection of Early Prostate Cancers Is Associated With High Mortality. Arch Intern Med. 2005;165(6):702. doi:10.1001/archinte.165.6.702-a