Advertisement
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.
You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2010

141 STAGE MIGRATION IN PROSTATE CANCER AT RADICAL PROSTATECTOMY DURING THE PSA ERA IS ASSOCIATED WITH RELATIVELY CONSTANT GLEASON SCORE

    View All Author Information

    INTRODUCTION AND OBJECTIVES

    PSA screening has been associated with a sharp increase in the detection of prostate cancer (PCA) after its introduction. The increase in PCA detection has been reported to be accompanied by a decrease in the incidence of high-grade, high-risk PCA with a pathologic stage migration toward organ confined disease.

    METHODS

    A cohort of 471 patients who underwent radical prostatectomy (RP) for clinically localized PCA between 1987 and 2004 were included in the study. Cases were selected using data from approximately 125 patients with clinical recurrence and 375 without clinical recurrence after RP. All surgical specimens were reviewed blindly by a single pathologist, staged and graded according to the 2005 ISUP consensus conference. Gleason score (GS) and pathologic stage (T) distribution was examined in the early (1987-1998) vs. late (1999-2004) PSA era. For purposes of analysis, GS was subdivided in three categories: GS≤6, GS=7 and GS≥8 (high-grade PCA).

    RESULTS

    Patients mean age was 62.9 (range 43-76) in early-PSA-era and 60.9 (range 42-77) years in late-PSA-era, respectively (p=0.001). Mean pre-operative PSA (iPSA) was 12.14 in early-PSA-era and 6.96 ng/ml in late-PSA-era, respectively (p<0.0001). GS was ≤ 6 in 81 cases, 7 in 215 cases, and ≥8 in 175 cases. Compared with the original pathology report, 93 (19.7%) cases were upgraded and 10 (2.1%) downgraded after review. Stage was T2 in 180 cases, T2 with surgical margin positive in 43 cases and T3 in the remaining 248 cases. Upon review, 12 (2.5%) cases were upstaged from T2 to T3. There was no difference in the numbers of cases in the three GS categories between the two PSA periods neither by univariable analysis (Chi-Square=3.1, p=0.2), or by multivariable logistic regression analysis while adjusting for iPSA and age (Odds Ratio [OR] = 1.1; 95% Confidence Interval [CI]: 0.8-1.6; p=0.5). A significant difference was found in the numbers of cases in the T stages categories between the two PSA eras (Chi-Square=21.0, p <0.00003); such difference was still significant after adjustment for iPSA and age (OR= 0.6; 95% CI: 0.5-0.9, p=0.003)

    CONCLUSIONS

    Prostate cancer screening with lower PSA cutoffs has lead to a stage migration with a significant increase in organ confined PCA in RP specimens, whereas the GS distribution and the percentage of high-grade PCA has remained relatively constant overtime. This finding challenges the hypothesis of tumor progression.

    Cleveland, OH

    Advertisement