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Prostate cancer staging and grading at radical prostatectomy over time
Sara Moscovita Falzarano1, Cristina Magi-Galluzzi
1Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
Advances in Anatomic Pathology
|February 18, 2011
Summary
Prostate-specific antigen (PSA) testing has increased prostate cancer (PCA) detection, leading to earlier diagnosis. However, changes in Gleason grading practices, not tumor biology, likely explain observed shifts in disease severity over time.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Prostate-specific antigen (PSA) testing, introduced in the late 1980s and widely adopted in 1994, significantly increased prostate cancer (PCA) detection rates.
- This led to a shift towards diagnosing younger patients at lower serum PSA levels and a downward migration in clinical and pathologic stage at diagnosis.
Purpose of the Study:
- To review trends in prostate cancer (PCA) staging and grading from the pre-PSA era to the present.
- To emphasize the influence of evolving clinical and pathologic practices on these observed trends.
Main Methods:
- Literature review examining temporal patterns in PCA diagnosis, staging, and grading.
- Analysis of studies investigating the impact of PSA testing on disease characteristics.
Main Results:
- PSA testing has led to earlier detection and a decrease in advanced stage PCA diagnoses.
- Observed shifts in tumor grade distribution over time are more likely due to changes in Gleason grading practices than alterations in tumor biology.
Conclusions:
- PSA testing has altered the landscape of PCA detection, favoring earlier and less advanced diagnoses.
- Understanding changes in clinical and pathologic practices is crucial for interpreting trends in PCA staging and grading.
