Issues

The cover images of H&E prostate tissue sections illustrate the potential variance between definitive prostatectomy scoring and nondefinitive biopsy scoring of prostate cancer in the Prostate Cancer Prevention Trial (PCPT). The two prostatectomy tissue sections (from the same patient) showed clinically “significant” cancer (Gleasonscore 7 [3+4], plus two foci at 6 [3+3]), whereas the corresponding diagnostic needle biopsy suggested clinically “insignificant” cancer ofGleason score 6 (3+3). Specimens came from a PCPT participant with a PSA of 2.1 ng/ml and stage T1c prostate cancer. See article by Lucia et al. on page 167 for more information (featured in The New York Times on June 15, 2008). Graphic design courtesy of Lisa Litzenberger. Also shown is a graph (lower left inset) illustrating the relative risk of high-grade disease with finasteride in the PCPT under various values of biopsy sensitivity for detecting cancer and incorporating PCPTprostatectomy data to account for the greater grading accuracy of biopsy with finasteride. In the orange-shaded region, all values of finasteride and placebo biopsy sensitivity reduce the risk of high-grade cancer; in the unshaded region, the 95% confidence intervals around the relative risk estimates include 1. The bold blue line representsthe estimated reduction in high-grade risk given equal biopsy sensitivities for placebo and finasteride. See article by Redman et al. on page 174 for more information (featured in The New York Times on June 15, 2008).