Gleason Grading Controversies: What the Chemoprevention Trials Have Taught Us

The Prostate Chemoprevention Trial (PCPT) evaluated finasteride's effectiveness in reducing prostate cancer incidence and found a 30% reduction in cancer incidence. Initially, patients on finasteride who developed cancer had higher Gleason scores than those on placebo. However, further analysis revealed that biopsy Gleason scores were more accurate in finasteride patients compared to placebo when matched with radical prostatectomy scores. This increased accuracy was attributed to finasteride-induced prostate volume reduction and improved prostate-specific antigen correlation, which helped identify high-grade cancer more effectively. Ultimately, there were no significant differences in Gleason scores between the finasteride and placebo groups.