Monday, 26-Jun-2006   

 Since the clinical introduction of PSA testing, there is reason to
hypothesize that prostate cancer (CaP) Gleason grades may have shifted
due to a variety of factors. 

Dr. Sengupta and associates at the Mayo Clinic report this to be the
case in the epub version of Cancer.

Between 1989 and 2001, 8750 patients who underwent radical prostatectomy
at the Mayo clinic met the study criteria.  Gleason grades over the 13
year period were reviewed and biochemical recurrence (defined as a PSA

was estimated using Kaplan Meier methodology. 

The percentage of RP specimens assigned a Gleason grade of 3 as either
the primary or secondary grade increased from 86% vs. 49% for primary
and 71% vs. 47% for secondary pattern for
1999-2001 vs. 1989-1999, respectively.

During the same time periods, the prevalence of Gleason grade 2 tumors
decreased from 0.4% vs. 38% for primary and 1.3% vs. 28% for secondary
Gleason grade patterns.  As a result, less Gleason score 4-5 tumors
and more Gleason score 6-7 tumors were identified. 

The BRFS for patients with Gleason score 6 and 7 tumors improved over
the time periods.  For Gleason score 6 the 5-year BRFS improved form
47% to 87% over the two time periods.  For Gleason score 7 the 5-year
BRFS improved form 51% to 66% over the two time periods.  There were
no significant changes noted over the same time periods for Gleason
scores 2-4 or 8-10.  In multivariate analysis, improved BRFS remained
for Gleason score 6, but not for patients with Gleason score 7
tumors. 

The noted Gleason grade shifts may be a result of true stage migration
secondary to PSA screening or changes in pathologic interpretation over
the time period studied.

By Christopher P. Evans, MD

Reference:

Cancer. 2006 Jun 15;106(12):2630-5.
http://www.ncbi.nlm.nih.gov/entrez/
Sengupta S, Slezak JM, Blute ML, Leibovich BC, Sebo TJ, Myers RP,
Cheville JC, Bergstralh EJ, Zincke H.

 

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc