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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 . . . [Full Text of this Article]

AUTHOR INFORMATION
Donald B. Louria, MD

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