Grade migration in prostate cancer: an analysis using the Surveillance, Epidemiology, and End Results registry

Abstract

To utilize the Surveillance, Epidemiology, and End Results (SEER) registry to examine trends in grade assignment. Data from 411 325 patients from 1984 to 2003 were analyzed for grade migration and for cause-specific survival (CSS) as a function of grade. There has been a significant grade migration during the study period (Po0.001), principally from well-differentiated (WD) to moderately differentiated (MD) disease. Five-year CSS of MD and WD patients have converged, suggesting a decreasing role of grade as a prognostic factor. A grade migration from WD to MD assignment has occurred, suggesting that prognostic categorizations based on grade across eras may be difficult to interpret.

Prostate cancer epidemiology in the United States

“…An overall grade migration has occurred in prostate cancer, primarily a shift from well-differentiated to moderately differentiated disease; this may confound grade-based prognostic categorizations in studies over time [12]. This migration occurred independent of patient age, reinforcing that the grade migration is likely due to changes in pathologic interpretation rather than to screening-related changes in disease characteristics.…”

Current Clinical Presentation and Treatment of Localized Prostate Cancer in the United States

“…2,3,6,7 The men in our study were diagnosed in 2010 after the 2008 USPSTF (United States Preventive Services Task Force) recommendation against PSA screening in men 75 years old or older but before the 2011 USPSTF recommendation against PSA screening in men of any age. 11 Interestingly in most men diagnosed with localized prostate cancer in 2010 no disease was palpable on digital rectal examination, indicating that they likely would not have been diagnosed with cancer if PSA screening had not been performed.…”

“…For instance, SEER studies of prostate cancer presentation before 2004 used the previous WHO grading system. 7 The most recent comprehensive SEER analysis of prostate cancer presentation evaluated men diagnosed between 2004 and 2005. 6 However, during that period the SEER database recorded only a single GS from the largest tumor specimen available, which was the prostatectomy rather than the biopsy specimen in men who underwent prostatectomy.…”

Parameters predicting postoperative unilateral disease in patients with unilateral prostate cancer in diagnostic biopsy: a rationale for selecting hemiablative focal therapy candidates

“…13,14 This shift in prostate cancer epidemiology and diagnosis has forced the re-examination of the standard radical therapies, such as radiation therapy and prostatectomy. Given that many patients are now diagnosed early and most of them suffer from low-malignant potential cancer and will not die from the disease, conservative treatment strategies, such as active surveillance and watchful waiting, have been introduced.…”