title: Gleason drift in the NIHR ProtecT study.
abstract: OBJECTIVE
  There is increasing evidence of Gleason score (GS) drift in prostatic core biopsies during the last two decades. The ProtecT study is a randomized controlled study and provides an excellent cohort to study the effect of time, prostate-specific antigen (PSA) level, perineural invasion, tumour length and age on GS.
  
  
  RESULTS
  The ProtecT study recruited men in the United Kingdom between 1999 and 2010. The Gleason scores were grouped into four categories ≤ 3 + 3, 3 + 4, 4 + 3 and ≥ 4 + 4 for analysis. Data from England between 2000 and 2012 were also available. A total of 3282 biopsies containing cancer were analysed. For each year of the ProtecT study, the odds of being diagnosed with a higher GS category increased by 4.9%. Higher GS was also associated with perineural invasion, increasing tumour length, age and PSA level. While biopsy GS from England was incomplete, it also showed a marked decrease in GS five and six tumours during the same period.
  
  
  CONCLUSIONS
  There was GS drift from 3 + 3 to 3 + 4 with time in the ProtecT study, but there appeared to be no significant change in percentage of GS 4 + 3 or higher. This drift was less dramatic when compared to GS in the rest of England.
authors.affiliation: Department of Cellular Pathology, Southmead Hospital, Bristol, UK.
authors.forename: Jon
authors.initials: J
authors.lastname: Oxley
authors.forename: Andrew
authors.initials: A
authors.lastname: Simpkin
authors.forename: John
authors.initials: J
authors.lastname: Goepel
authors.forename: Murali
authors.initials: M
authors.lastname: Varma
authors.forename: David
authors.initials: D
authors.lastname: Griffiths
authors.forename: Ken
authors.initials: K
authors.lastname: Grigor
authors.forename: Nick
authors.initials: N
authors.lastname: Mayer
authors.forename: Anne
authors.initials: A
authors.lastname: Warren
authors.forename: Nayneeta
authors.initials: N
authors.lastname: Deshmukh
authors.forename: Selina
authors.initials: S
authors.lastname: Bhattarai
authors.forename: John
authors.initials: J
authors.lastname: Dormer
authors.forename: Luke
authors.initials: L
authors.lastname: Hounsome
authors.forename: Lukasz A
authors.initials: LA
authors.lastname: Adamczyk
authors.forename: Christopher
authors.initials: C
authors.lastname: Metcalfe
authors.forename: J Athene
authors.initials: JA
authors.lastname: Lane
authors.forename: Michael
authors.initials: M
authors.lastname: Davis
authors.forename: Jenny L
authors.initials: JL
authors.lastname: Donovan
authors.forename: David E
authors.initials: DE
authors.lastname: Neal
authors.forename: Freddy C
authors.initials: FC
authors.lastname: Hamdy
authors.forename: Mary C
authors.initials: MC
authors.lastname: Robinson
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000592:standards*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000628:therapy; D006113:United Kingdom
chemical_list: D017430:Prostate-Specific Antigen
keywords: Gleason; ProtecT; biopsy; drift; prostate cancer