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75 years. The clinical significance of these findings is that older men with ��low-risk�� prostate cancer may harbour http://www.selleck.cn/products/wortmannin.html occult high grade prostate cancer that can be missed because of prostate biopsy sampling error despite extended (10�C14-core) biopsy, placing them at increased risk of PCSM within a few years of the diagnosis when non-curative treatments such as active surveillance are used initially. This is of particular concern because it was standard practice during the study period, and also today, to perform an extended-core biopsy before recommending active surveillance, as well as in surveillance biopsy schemes for patients managed with active surveillance. Data from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database indicate that, in the year 2004, the mean number of cores obtained at biopsy in men with newly diagnosed prostate cancer was 10.2, a number which had risen with time; in 1995, the mean number of cores obtained was only 6.9 [22]. In contrast to older men, younger men are at markedly lower risk of undergrading [15]. In the present study, the nonsignificant association between non-curative management approaches and the cumulative incidence of PCSM in men aged ��67 years (P = 0.17) suggests that less undergrading is occurring in younger than in older men; however, the present analysis is significantly limited by a small number of events (n = 16) in this cohort of men ��67 years of age. To better assess the impact of curative therapy http://www.selleckchem.com/products/LY294002.html on this cohort, a larger sample size and longer follow-up are required. Several points warrant additional discussion. First, a possible explanation for the association between increasing age and the risk of PCSM may be derived from the established relationship between older age and high grade disease, as seen in the Prostate Cancer Prevention Trial [9]. Undergrading of prostate cancer owing to limitations in http://www.selleckchem.com/products/CHIR-99021.html current biopsy techniques [12-14] may, therefore, be particularly consequential in older men, in whom undergrading is known to be more common owing to increasing gland volume coupled with increasing prevalence of BPH [15]. Moreover, even among the most favourable setting of ��very low-risk�� prostate cancer [19], (defined as a clinical classification of T1c, Gleason score ��6, PSA