Chemoprevention in Prostate Cancer

Drs. Lowe and Frazee provided a timely update of prostate cancer chemoprevention in their recent article in Pharmacotherapy. However, the issue of high-grade disease in the Prostate Cancer Prevention Trial (PCPT) deserves some clarification. In both the abstract and in the section on finasteride, Drs. Lowe and Frazee inadvertently used the terms “invasive” and “high grade” interchangeably when stating that in addition to the primary study finding of a 24.8% decrease in the 7-year prevalence of prostate cancer, finasteride was associated with a small, but statistically significant increase in cancers with a Gleason score of 7–10. In fact, all of the prostate cancers reported in the PCPT represent invasive tumors. The impact of finasteride on noninvasive tumors (e.g., highgrade intraepithelial neoplasia) will be the subject of a future publication (that we are working on). In addition, detailed analyses of prostate biopsy and prostatectomy specimens, allowing us to address the potential role of detection bias (enhanced detection of high-grade disease in the smaller, finasteride-treated glands) in the PCPT grade findings, will also be forthcoming. The distinction between terms such as invasive and high grade is not a semantic one, but rather serves to illustrate the importance of subtle nuances in the increasingly complex field of chemoprevention. We are not simply trying to point out errors, but our reason for this missive is to emphasize how complex the field of chemoprevention has become. One needs to be well versed in the jargon in order to appreciate these fine differences. Again, we appreciate the enormous effort that Drs. Lowe and Frazee have made in their comprehensive review.