The effect of prostate-specific antigen screening during the last decade: development of clinicopathological variables independently of the biopsy core number.
OBJECTIVE
To study the development of stage migration in prostate cancer after controlling for the number of biopsy cores.


METHODS
In all, 1826 patients had a first set of 21-core biopsies taken between 2001 and 2008. Among the 801 patients with prostate cancer, 443 had a laparoscopic radical prostatectomy (RP). Patients were divided into three subsets according to the date of biopsy, i.e. period 1 (2001-2003), period 2 (2004-2005), and period 3 (2006-2008). Study end points were the development over time of: (i) clinico-biological characteristics; (ii) biopsy variables; (iii) pathological RP features; and (iv) the biochemical recurrence-free (RFS) rate after surgery.


RESULTS
The mean age decreased significantly over time (P = 0.004). The proportion of men with a prostate-specific antigen (PSA) level of 4-10 ng/mL increased significantly over time at the expense of the proportion of men with a PSA level of ≥ 10 ng/mL (P = 0.004). A biopsy Gleason score of ≥ 7 was reported in 53.9% of period 1, compared to 39.6% in period 3 (P = 0.001). RP specimens had a significantly lower proportion of extraprostatic disease (P = 0.013), of high Gleason scores (P = 0.049), and positive margins (P = 0.011) over time. The RFS curves did not vary over time (P = 897).


CONCLUSIONS
Current candidates for prostate biopsy are younger and have lower PSA levels than those who had biopsies taken at the beginning of the decade. Cancers are less aggressive in terms of Gleason score, extent of the disease on biopsy cores and rate of extraprostatic disease on RP specimens than those diagnosed at the beginning of the decade.
Ploussard
Guillaume
G
INSERM U955 Eq07, Department of Urology, APHP, CHU Henri Mondor, Créteil, France.
Azancot
Vidal
V
Nicolaiew
Nathalie
N
Xylinas
Evanguelos
E
Salomon
Laurent
L
Allory
Yves
Y
Vordos
Dimitri
D
Hoznek
Andras
A
Abbou
Claude-Clément
CC
de la Taille
Alexandre
A
D000328:Adult; D000367:Age Factors; D000368:Aged; D001707:Biopsy, Needle; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000473:pathology*; D009367:Neoplasm Staging; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D013997:Time Factors
D017430:Prostate-Specific Antigen