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To the Editor: In their study of the long-term outcomes following conservative management of localized prostate cancer, Dr Albertsen and colleagues¹ conclude that a Gleason score of 2 to 4 is a very good prognostic sign. However, the Gleason score is a highly subjective measure that is based on a pathologists’ perception of tissue patterns. A much more objective prognostic measure is the DNA content or ploidy of tumor cells.^2-3

Carcinomas with normal, near-normal, or diploid DNA content are less aggressive and less likely to extend beyond the prostate than nondiploid (aneuploid) cancers.^3-4 As recently suggested by Lorenzato et al,⁵ therapeutic decisions that depend on the extent of prostate cancer (organ-confined T1T2 or non–organ-confined T3T4) can be helped by DNA analysis of the tumor, potentially reducing the rate of unnecessary radical prostatectomy with its attendant adverse effects of incontinence and impotence. For example, in patients with prostate-specific antigen levels of . . . [Full Text of this Article]

Leopold G. Koss, MD
lkoss@montefiore.org
Montefiore Medical Center
Bronx, NY

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