[842] Stage Migration in Prostate Cancer at Radical Prostatectomy during the PSA Era Is Associated with Relatively Constant Gleason Score

SM Falzarano, M Zhou, AV Hernandez, EA Klein, C Magi-Galluzzi. Cleveland Clinic, Cleveland, OH; Lerner Research Institute, Clevaland, OH

Background: Prostate specific antigen (PSA) screening has been associated with a sharp increase in prostate cancer (PCA) detection after its introduction in the late 1980s. Increase PCA detection has been associated with decreased incidence of high-grade, high-risk PCA with a stage migration toward organ confined (OC) disease.
Design: 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 patients with (n=125) and without (n=375) clinical recurrence after RP. All surgical specimens were reviewed blindly by a pathologist, staged and graded according to the 2005-ISUP consensus conference on Gleason grading. Gleason score (GS) and pathologic stage (T) distribution was examined in the early (1987-1998) vs. late (1999-2004) PSA-era.
Results: Patients mean age was 62.9 and 60.9 years in early-PSA-era and late-PSA-era, respectively (p=0.001). Mean pre-operative PSA (iPSA) was 12.14 and 6.96 ng/ml in early-PSA-era and late-PSA-era, respectively (p<0.0001). Compared with the original report 19.7% of cases were upgraded, 2.1% downgraded and 2.5% upstaged from T2 to T3. GS and stage distribution among PSA-eras is reported in Table 1.

Table 1
PSA era
early (n=228)late (n=243)p value
GS≤6 (17%)3744* p=0.2; ** p=05
GS7 (46%)97118
GS≥8 (37%)9481
T2 (38%)63117* p<0.00003; ** p=0.003
T3 (53%)141107
T2+ (9%)2419
T2+: T2 with margins positive

There was no difference in the numbers of cases in the GS categories between PSA periods neither by univariable (Chi-Square*), or by multivariable logistic regression analysis while adjusting for iPSA and age (**). A significant difference was found in the numbers of cases in T stages categories between the two PSA-eras (* p<0.00003); such difference was still significant after adjustment for iPSA and age (** p=0.003) (Table 1).
Conclusions: PCA screening with lower PSA cutoffs has lead to a stage migration with a significant increase in the percentage of OC 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.
Category: Genitourinary (including renal tumors)

Monday, March 22, 2010 1:00 PM

Poster Session II # 124, Monday Afternoon

 

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