Time Trends in Clinical Risk Stratification for Prostate Cancer: Implications for Outcomes (Data From CaPSURE)

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

“…[19][20][21][22][23] Grading inconsistencies have been examined in the context of extended biopsy 24 and in the context of influencing radiotherapy decisions. 25 A recent regional database analysis of the Connecticut Tumor Registry documented a grade migration, with a demonstrated decline in the incidence of low-grade disease when reread by experienced pathologists blinded to the original classification. 26 Additionally, an analysis using the CaPSURE database revealed a shift from low-to intermediate-grade disease.…”

“…27 Our study demonstrates that a significant grade migration has occurred from the period just before the widespread of PSA screening (1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003) to more recent periods. While several single-institution and regional database analyses have explored this phenomenon, [17][18][19][20][21][22][23][24][25] ours is the largest such analysis in the PSA era using a national public-access database. The results indicate that grade migration has occurred across all stages of nonmetastatic disease and confirms that the most significant grade migration has occurred in early-stage disease.…”

“…If PSA were available, we would expect a slow decrease, as shown by analysis of the CaPSURE database. 25 An additional limitation is that Gleason grade cannot be analyzed on the original scale from 2 to 10, as the SEER system (WD, MD, PD) collapses Gleason grade into three instead of nine categories. This, however, is not a major limitation to our findings as such a grouping would likely have been done before analysis, and if anything, such a grouping underestimates the grade migration.…”

Evidence-Based Comparison of Robotic and Open Radical Prostatectomy

“…Since the advent of prostate-specific antigen (PSA) screening and with the incorporation of expanded biopsy templates, prostate cancer is now diagnosed in younger men and at earlier stages, resulting in an increased use of local treatment, specifically radical prostatectomy (RP)[4]. Originally introduced by Terrence Millin in 1945 and then significantly refined by Patrick Walsh and colleagues in the 1980s, open radical retropubic prostatectomy (ORP) has long been considered the gold-standard treatment of clinically localized prostate cancer[5,6].…”

Disproportionate Presentation of High Risk Prostate Cancer in a Safety Net Health System

“…1 This stage migration is attributed to widespread PSA screening with improved outcomes and decreasing cancer specific mortality, presumably due to early intervention for disease. 2 However, most of these studies are based on data on patients in academic series, which typically reflect a relatively homogeneous, narrow sociodemographic range. 3 Previous studies show that prostate cancer incidence and mortality can vary greatly by race, ethnicity and socioeconomic status.…”