Changing face and different countenances of prostate cancer: Racial and geographic differences in prostate‐specific antigen (PSA), stage, and grade trends in the PSA era

Abstract

SUMMARY The purpose of this investigation was to examine changes in pretreatment prostate-specific antigen (PSA), stage, and grade over the past decade as a function of race and geographic region. A multiinstitutional database representing 6,790 patients (1,417 African-American, 5,373 white) diagnosed with nonmetastatic prostate cancer between 1988 and 1997 was constructed. PSA, stage, and grade data were tabulated by calendar year and region, and time trend analyses based on race and region were performed. There was an overall decline of PSA of 0.8%/year, which was significant (P = 0.0001), with a faster rate of decline in African-Americans (1.9%/year) than for whites (0.6%/year). The odds ratio (OR) for a stage shift was 1.09, which was significant (P < 0.0001), and this shift was greater in whites. The OR for an overall grade shift was 1.15, which was significant (P < 0.0001). Although grade and PSA trends were similar for the different regions, there were significant regional differences in stage trends. The implications are that the face of prostate cancer has changed over the past decade; i.e., the distributions of stage, grade, and PSA (the most important prognosticators) have changed. In addition, the countenances of that face are different for whites and African-Americans. For African-Americans, this is good news: the stage, grade, and PSA distributions are more favorable now than before. For whites, the trends are more complex and more dependent on region. These

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

“…These stage and PSA trends are largely consistent with those reported previously. [2][3][4] The relatively consistent proportion of cases diagnosed with PSA less than 4 ng/ml, including many that have intermediate or high risk features based on Gleason score and/or T stage, underscores the continued importance of digital rectal examination in detecting cases that are falsenegative by PSA screening alone. 13 Overall, we found a trend toward higher Gleason scoring with time.…”

“…1 PSA screening has effected downward biochemical and clinical stage migrations, with the result that a given newly diagnosed prostate cancer is likely to be of lower stage and associated with a lower serum PSA than previously. [2][3][4] On the other hand, recent reports have illustrated a trend during the last decade toward upgrading in terms of Gleason scoring. 5 The risk assessment system devised by D'Amico et al assigns patients to low, intermediate or high risk groups based on clinical T stage, serum PSA and Gleason score.…”

Minimal Impact of Clinical Stage on Prostate Cancer Prognosis Among Contemporary Patients With Clinically Localized Disease

“…6 The widespread prevalence of PSA screening for prostate cancer has led to a significant migration toward lower stage, lower risk tumors. 7,8 As the majority of tumors encountered in today's practice are cT1c lesions, there is less stratification by clinical stage than had been seen in the past. Additionally, it has been shown that numerous clinical variables including pretreatment PSA, biopsy Gleason score and PPB are strong predictors of biochemical recurrence after radical prostatectomy, potentially stronger than clinical T stage.…”

The Contemporary Management of Prostate Cancer in the United States: Lessons From the Cancer of the Prostate Strategic Urologic Research Endeavor (Capsure), a National Disease Registry

“…1 Early detection of cases has produced downward stage migration at presentation. 2,3 Earlier diagnosis and therapeutic advances have facilitated the increased use of aggressive local treatment, particularly radical prostatectomy (RP), external beam radiotherapy (EBRT) and more recently interstitial radiotherapy (brachytherapy). 3 Evidence increasingly demonstrates a decrease in prostate cancer mortality with local treatment of low stage disease.…”