Letter to the Editor
Genetic correlates of prostate cancer visibility (and invisibility) on mpMRI: It’s time to take stock.
In their paper on multiparametric magnetic resonance imaging , Norris et al. argue that because “men with overall Gleason score 3 + 4 [do] not suffer prostate cancer-related death” and “men with overall Gleason score 4 + 3 [do not have] negative pre-biopsy mpMRI” therefore “mpMRI may identify all truly significant cancer”. This may be behind the senior author’s recent remarks to the media  that mpMRI is “pretty close to perfect” and that men with a clean MRI can be confidently told that they never need worry about the disease.
The problem with the authors’ argument is that it is one of the premises is false. They cite the SPCG-4 study to support their claim that Gleason 3 + 4 prostate cancer cannot lead to death. But table 3 of the SPCG-4 publication clearly shows prostate cancer death in 5 of the 87 men with Gleason 3 + 4 disease. The authors’ claim seems to be based on a hazard ratio close to 1 (95% C.I. 0.23 to 4.33) for Gleason 3 + 4 vs. Gleason 3 + 3 in a multivariable model adjusting for age, pathologic stage and PSA. It should go without saying that failure to demonstrate that Gleason 3 + 4 is statistically different to Gleason 3 + 3 cannot be used to conclude that “men with overall Gleason 3 + 4 [do] not suffer prostate cancer-related death”. One can only speculate on the reasons for such a gross misrepresentation of the literature.
Memorial Sloan Kettering Cancer Center
Department of Epidemiology and Biostatistics
485 Lexington Avenue, 2nd Floor
New York, NY 10017
Email: [email protected]
Disclosures: Andrew Vickers is a co-inventor of the 4kscore, a commercially available reflex test for predicting prostate biopsy. He may receive royalties from sales of the test. He owns stock options in Opko, which offers the test.
 Norris JM, Simpson BS, Parry MA, et al. Genetic correlates of prostate cancer visibility (and invisibility) on mpMRI: It’s time to take stock. BJU international. 2019 Oct 10:
 Bodkin H. New prostate cancer test will give men ‘peace of mind’ that they will never develop the disease, scientists say. The Telegraph. 2019 June 9, 2019
 Bill-Axelson A, Holmberg L, Garmo H, et al. Radical Prostatectomy or Watchful Waiting in Prostate Cancer – 29-Year Follow-up. The New England journal of medicine. 2018 Dec 13: 379:2319-29