Prostate Cancer Stage vs. Gleason Score
August 28, 2013
Dennis R. Hill M.D. Radiation Oncologist at the Alta Bates Summit Medical Center in Oakland, CA reports that a recently published study confirms his experience that PSA screening has detected prostate cancer at a much earlier stage or tumor size. The journal Cancer Research published August 14, 2013 Abstract looked at 1,207 men who were diagnosed with prostate cancer from 1982 to 2004 and subsequently treated with surgery as their treatment for prostate cancer. They found that the proportion of advanced-stage tumors (≥T3) dropped from 19.9% during the earliest period of the study (1982–1993, when PSA screening was not well established) to 3% during the latest period of the study (2000–2004). In other words, the proportion of advanced stage tumors dropped more than six-fold from the pre PSA screening era to the PSA screening era.
On the other hand, they report the proportion of high Gleason scores or the appearance of the cancer cells when viewed under a microscope decreased substantially less. Gleason grade 4 + 4 prostate cancer or greater dropped from 25.3% to 17.6% across the pre-PSA and PSA screening eras. It is unknown whether prostate cancers arise well differentiated and then progress to less differentiated forms. However, this study says that Gleason grade is an early and largely unchanging feature because the expectation is that Gleason grade and clinical stage would progress together. Prostate cancer treatment options take into account both stage and Gleason score.
They conclude, “This has implications for the understanding of tumor progression and prognosis, and may help patients diagnosed with lower grade disease feel more comfortable choosing active surveillance.”
Dr. Hill says, “I know that we have a higher cure rate with a lower stage of disease but this report suggests that there is a group of men with low grade disease that can be safely followed since Gleason grade progression is relatively uncommon.”
Dr. Hill has been doing High Dose Rate Brachytherapy exclusively since 2004 and has published scholarly articles on the subject. His office is located at: Dennis R. Hill MD 3012 Summit Street Suite 2675 Oakland, CA | 94609 510-869-8875 | drh(at)dennisrhillmd(dot)com and his website is hdrprostatebrachytherapy.com, which includes a quiz to determine if a patient is a candidate for HDR Prostate Brachytherapy.