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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 al^3-4 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 . . . [Full Text of this Article]

Jonathan R. Osborn, MBChB, MSc, MRCS
j.osborn@prostatecancerresearch.org

Gerald W. Chodak, MD
Midwest Urology Research Foundation
Chicago, Ill

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