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

J Med Screen 2009;16:98-101
doi:10.1258/jms.2009.009037
© 2009 Medical Screening Society

 

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Original Articles


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


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

Methods Between 2002 and 2005, 1514 men aged 50–69 years wereidentified with prostate cancer following community-based PSAtesting as part of the ProtecT study. In the same period, 2021men aged 50–69 years with clinically diagnosed prostatecancer were registered at a population-based cancer registryin the East of England. Using logistic regression analysis andcontrolling for age, the odds ratio (OR) for advanced stage(TNM stage T3 and above) prostate cancer among the PSA-detectedgroup was compared with the clinically diagnosed tumours. Theevidence that stage shift differs by Gleason score was assessedusing 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 lengthbias or overdiagnosis. These findings may have implicationson understanding pathways of prostate cancer progression andon identifying potential targets for screening, pending furtherinvestigation of complexities of associations between PSA testing,Gleason score, and stage.


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