Gleason grading controversies: what the chemoprevention trials have taught us

Authors

  • Laurence Klotz Professor, Department of Surgery, University of Toronto, Toronto, ON
  • Darrel Drachenberg Assistant Professor and Director of Research, Department of Surgery, Section of Urology, University of Manitoba, Winnipeg, Manitoba
  • Yves Fradet Professor of Surgery/Urology, Department of Urology, Laval University, Québec, QC
  • Fred Saad Professor of Surgery and Urology, University of Montréal, Montréal, QC
  • John Trachtenberg Professor of Surgery and Medical Imaging, University of Toronto, Toronto, ON
  • Alexandre Zlotta Professor, Department of Surgery, University of Toronto, Toronto, ON

DOI:

https://doi.org/10.5489/cuaj.1115

Abstract

The recent Prostate Chemoprevention Trial (PCPT), which assessed the efficacy
of finasteride in reducing prostate cancer incidence, showed promising results.
However, patients who developed cancer had higher Gleason scores than those
on placebo. Moreover, recent evidence has shown that the biopsy Gleason scores
in patients on finasteride were actually more accurate compared with patients
on placebo when matched with the final, radical prostatectomy (RP) scores. This
accuracy was due to a reduction in prostate volume induced by the drug, and
better performance of prostate-specific antigen correlation for identifying men
with high-grade cancer. Re-evaluation of the results based on the pathology of
the RP specimens and longer follow-up showed a 30% reduction in cancer
incidence with finasteride and no significant differences in Gleason scores
compared with placebo

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Author Biographies

Laurence Klotz, Professor, Department of Surgery, University of Toronto, Toronto, ON

Darrel Drachenberg, Assistant Professor and Director of Research, Department of Surgery, Section of Urology, University of Manitoba, Winnipeg, Manitoba

Yves Fradet, Professor of Surgery/Urology, Department of Urology, Laval University, Québec, QC

Fred Saad, Professor of Surgery and Urology, University of Montréal, Montréal, QC

John Trachtenberg, Professor of Surgery and Medical Imaging, University of Toronto, Toronto, ON

Alexandre Zlotta, Professor, Department of Surgery, University of Toronto, Toronto, ON

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How to Cite

Klotz, L., Drachenberg, D., Fradet, Y., Saad, F., Trachtenberg, J., & Zlotta, A. (2013). Gleason grading controversies: what the chemoprevention trials have taught us. Canadian Urological Association Journal, 3(3-S2), S115-S120. https://doi.org/10.5489/cuaj.1115

Issue

Vol. 3 No. 3-S2 (2009): CUAJ June-Suppl 2

Section

Review

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