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Prostate cancer

Is prostatectomy for Gleason score 6 a treatment failure?

The contemporary plea for a more liberal pathological definition of insignificant prostate cancer was recently challenged by Schiffmann and colleagues, who advocate a return to the original, stringent 0.5 ml tumour volume threshold. This cut-off point would render fewer men eligible for active surveillance programmes.

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  1. 1

    Schiffmann, J. et al. Tumour volume in insignificant prostate cancer: increasing threshold gains increasing risk. Prostate

  2. 2

    Draisma, G. et al. Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context. J. Natl Cancer Inst. 101, 374–383 (2009).

    Article  Google Scholar 

  3. 3

    Van der Kwast, T. H. & Roobol, M. J. Defining the threshold for significant versus insignificant prostate cancer. Nat. Rev. Urol. 10, 473–482 (2013).

    Article  Google Scholar 

  4. 4

    Wolters, T. et al. A critical analysis of the tumour volume threshold for clinically insignificant prostate cancer using a data set of a randomized screening trial. J. Urol. 185, 121–125 (2011).

    Article  Google Scholar 

  5. 5

    Iremashvili, V. et al. Pathologic prostate cancer characteristics in patients eligible for active surveillance: a head-to-head comparison of contemporary protocols. Eur. Urol. 62, 462–428 (2012).

    Article  Google Scholar 

  6. 6

    Hong, S. K, Vertosick, E., Sjoberg, D. D., Scardino, P. T. & Eastham, J. A. Insignificant disease among men with intermediate-risk prostate cancer. World J. Urol.–3.

  7. 7

    Donin, N. M., Laze, J., Zhou, M., Ren, Q. & Lepor, H. Gleason 6 prostate tumours diagnosed in the PSA era do not demonstrate the capacity for metastatic spread at the time of radical prostatectomy. Urology 82, 148–152 (2013).

    Article  Google Scholar 

  8. 8

    Ross, H. M. et al. Do adenocarcinomas of the prostate with Gleason score (GS) ≤6 have the potential to metastasize to lymph nodes? Am. J. Surg. Pathol. 36, 1346–1352 (2012).

    Article  Google Scholar 

  9. 9

    Kweldam, C. F., Wildhagen, M. F., Bangma, C. H. & van Leenders, G. J. Disease-specific death and metastasis do not occur in patients with Gleason score ≤6 on radical prostatectomy. BJU Int.

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Correspondence to Theodorus H. van der Kwast.

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The authors declare no competing financial interests.

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van der Kwast, T., Roobol, M. Is prostatectomy for Gleason score 6 a treatment failure?. Nat Rev Urol 12, 10–11 (2015).

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