Journal of Medical Screening > Volume 16, Number 2 > Pp. 98-101

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Original Articles

Stage shift in PSA-detected prostate cancers – effect modification by Gleason score

Nora Pashayan, Cancer Research UK Training Fellow  , Department of Public Health and Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge, CB2 OSR, UK

Paul Pharoah, Cancer Research UK Senior Clinical Research Fellow , Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK

David E Neal, Professor of Surgery , Uro-Oncology Group, University of Cambridge, Department of Oncology, Box 279 (S4) Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK

Freddie Hamdy, Professor of Surgery and Head of Nuffield Department of Surgery , Nuffield Department of Surgery, University of Oxford, Oxford John Radcliffe Hospital Hospital, Headington, Oxford, OX3 9DU, UK

Jenny Donovan, Professor of Social Medicine and Head of Department of Social Medicine , Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK

Richard M Martin, Reader in Clinical Epidemiology , Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK

David Greenberg, Senior Analyst , Eastern Cancer Registration and Information Centre (ECRIC) Unit C, Magog Court, Shelford Bottom Hinton Way, Cambridge CB22 3AD, UK

Stephen W Duffy, Professor of Cancer Screening , Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, University of London, Charterhouse Square, London EC1M 6BQ, UK

Correspondence to: Nora Pashayan, Department of Public Health and Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge, CB2 2SR, UK; np275{at}medschl.cam.ac.uk

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Objective This paper aims to investigate whether the stage shift (where more cancers are detected at an earlier stage) in prostate-specific antigen (PSA)-detected cancers differs by Gleason score.

Methods Between 2002 and 2005, 1514 men aged 50–69 years were identified with prostate cancer following community-based PSA testing as part of the ProtecT study. In the same period, 2021 men aged 50–69 years with clinically diagnosed prostate cancer were registered at a population-based cancer registry in the East of England. Using logistic regression analysis and controlling for age, the odds ratio (OR) for advanced stage (TNM stage T3 and above) prostate cancer among the PSA-detected group was compared with the clinically diagnosed tumours. The evidence that stage shift differs by Gleason score was assessed using the likelihood ratio test for interaction.

Results Advanced stage disease among the PSA-detected cancers was less common than among the clinically detected cancers (OR = 0.47, 95% CI 0.39–0.56). PSA-detected tumours had a substantial shift to earlier-stage disease where the Gleason score was <7 (OR = 0.52; 95% CI 0.36–0.77, P < 0.001) but showed no such shift where the Gleason score was 7 or more (OR = 0.84; 95% CI 0.66–1.07, P = 0.1). There was evidence of interaction between detection mode and Gleason score (P = 0.03).

Conclusion The observed stage shift could be partially explained by length bias or overdiagnosis. These findings may have implications on understanding pathways of prostate cancer progression and on identifying potential targets for screening, pending further investigation of complexities of associations between PSA testing, Gleason score, and stage.

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