title: The face of high risk prostate cancer.
abstract: OBJECTIVE
  To define high risk prostate cancer using prostate cancer specific mortality as the key outcome metric.
  
  
  METHODS
  Data from two population based cohorts of men from Connecticut who were diagnosed with localized prostate cancer were analyzed to determine the natural history of prostate cancer and the impact of treatment on long term survival.
  
  
  RESULTS
  Men with Gleason 7-10 prostate cancer and a potential survival of 10 years have a high risk of dying from their disease if they elect active surveillance. Surgery appears to offer an improved survival for these men when compared to radiation therapy or observation. Men diagnosed with Gleason 6 tumors in the contemporary era are more likely to harbor low risk prostate cancer when compared to historical series.
  
  
  CONCLUSIONS
  Our studies confirm that high risk prostate cancer is best identified by Gleason score 7-10, but challenge the concept that men with high-grade disease are less likely to benefit from radical surgery. Men who have rising PSA values following treatment with either surgery or radiation have residual prostate cancer and are at very high risk of dying from prostate cancer within 10 years.
authors.affiliation: Division of Urology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3955, USA. Albertsen@nso.uchc.edu
authors.forename: Peter C
authors.initials: PC
authors.lastname: Albertsen
mesh_terms: D000368:Aged; D001706:Biopsy; D003131:Combined Modality Therapy / Q000379:methods; D003237:Connecticut / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors