Gleason Grading Controversies: What the Chemoprevention Trials Have Taught Us

    Laurence Klotz, Darrel Drachenberg, Yves Fradet, Fred Saad, John Trachtenberg, Alexandre R. Zlotta
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    Studysummary This study found that finasteride reduced prostate cancer incidence by 30%, with no significant difference in Gleason scores compared to placebo after re-evaluation of pathology and extended follow-up.
    Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer
    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.
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