Publication Type | Journal Article |
Year of Publication | 2013 |
Authors | Penney, KL, Stampfer, MJ, Jahn, JL, Sinnott, JA, Flavin, R, Rider, JR, Finn, S, Giovannucci, E, Sesso, HD, Loda, M, Mucci, LA, Fiorentino, M |
Journal | Cancer Res |
Volume | 73 |
Issue | 16 |
Pages | 5163-8 |
Date Published | 2013 Aug 15 |
ISSN | 1538-7445 |
Keywords | Aged, Disease Progression, Double-Blind Method, Follow-Up Studies, Humans, Male, Neoplasm Grading, Prognosis, Prostate-Specific Antigen, Prostatectomy, Prostatic Neoplasms, Randomized Controlled Trials as Topic |
Abstract | Gleason grade is universally used for pathologic scoring of the differentiation of prostate cancer. However, it is unknown whether prostate tumors arise well differentiated and then progress to less differentiated forms or if Gleason grade is an early and largely unchanging feature. Prostate-specific antigen (PSA) screening has reduced the proportion of tumors diagnosed at advanced stage, which allows assessment of this question on a population level. If Gleason grade progresses as stage does, one would expect a similar reduction in high-grade tumors. We studied 1,207 Physicians' Health Study and Health Professionals Follow-up Study participants diagnosed with prostate cancer from 1982 to 2004 and treated with prostatectomy. We compared the distribution of grade and clinical stage across the pre-PSA and PSA screening eras. We re-reviewed grade using the ISUP 2005 revised criteria. The proportion of advanced stage tumors dropped more than six-fold, from the earliest period (12/1982-1/1993), 19.9% stage ≥ T3, to the latest (5/2000-12/2004), 3% stage T3, none T4. The proportion of Gleason score ≥ 8 decreased substantially less, from 25.3% to 17.6%. A significant interaction between stage and diagnosis date predicting grade (P = 0.04) suggests that the relationship between grade and stage varies by time period. As the dramatic shift in stage since the introduction of PSA screening was accompanied by a more modest shift in Gleason grade, these findings suggest that grade may be established early in tumor pathogenesis. This has implications for the understanding of tumor progression and prognosis, and may help patients diagnosed with lower grade disease feel more comfortable choosing active surveillance. |
URL | http://cancerres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=23946472 |
DOI | 10.1158/0008-5472.CAN-13-0427 |
Pubmed | |
Alternate Journal | Cancer Res. |
PubMed ID | 23946472 |
PubMed Central ID | PMC3775342 |
Grant List | P50 CA090381 / CA / NCI NIH HHS / United States P01 CA055075 / CA / NCI NIH HHS / United States R01 HL034595 / HL / NHLBI NIH HHS / United States CA55075 / CA / NCI NIH HHS / United States 5R01CA141298 / CA / NCI NIH HHS / United States R01 CA034944-03 / CA / NCI NIH HHS / United States 5P50CA090381-08 / CA / NCI NIH HHS / United States CA097193 / CA / NCI NIH HHS / United States R01 HL026490 / HL / NHLBI NIH HHS / United States T32 CA009001 / CA / NCI NIH HHS / United States R01 HL034595-07 / HL / NHLBI NIH HHS / United States R01 CA040360 / CA / NCI NIH HHS / United States T32 CA009001-32 / CA / NCI NIH HHS / United States R01 HL026490-03 / HL / NHLBI NIH HHS / United States R01 CA097193 / CA / NCI NIH HHS / United States CA40360 / CA / NCI NIH HHS / United States R01 CA034944 / CA / NCI NIH HHS / United States R01 CA141298 / CA / NCI NIH HHS / United States |
Cancer Res DOI:10.1158/0008-5472.CAN-13-0427
Gleason grade progression is uncommon.
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