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.
|early (n=228)||late (n=243)||p value|
|GS≤6 (17%)||37||44||* p=0.2; ** p=05|
|T2 (38%)||63||117||* p<0.00003; ** p=0.003|