Prostate Cancer and the Will Rogers Phenomenon

Background: Information on tumor stage and grade are used to assess cancer prognosis and to produce standardized comparisons of end results over time. Changes in the interpretation of classification schemes can alter the apparent distribution of cancer stage or grade in the absence of a true biologi...

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Bibliographic Details
Published in:JNCI : Journal of the National Cancer Institute 2005-09, Vol.97 (17), p.1248-1253
Main Authors: Albertsen, Peter C., Hanley, James A., Barrows, George H., Penson, David F., Kowalczyk, Pam D. H., Sanders, M. Melinda, Fine, Judith
Format: Article
Language:English
Subjects:
Aged
Bias
Biological and medical sciences
Biopsy
Classification
Clinical Trials as Topic
Connecticut - epidemiology
Humans
Incidence
Male
Medical sciences
Middle Aged
Mortality
Mortality - trends
Neoplasm Staging
Nephrology. Urinary tract diseases
Prognosis
Prostate cancer
Prostate-Specific Antigen - blood
Prostatectomy
Prostatic Neoplasms - immunology
Prostatic Neoplasms - mortality
Prostatic Neoplasms - pathology
Prostatic Neoplasms - surgery
Registries
Retrospective Studies
Severity of Illness Index
Statistical analysis
Treatment Outcome
Tumors
Tumors of the urinary system
Urinary tract. Prostate gland
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Summary:Background: Information on tumor stage and grade are used to assess cancer prognosis and to produce standardized comparisons of end results over time. Changes in the interpretation of classification schemes can alter the apparent distribution of cancer stage or grade in the absence of a true biologic change. Since the introduction of prostate-specific antigen testing, the reported incidence of low-grade prostate cancer has declined. To determine whether this decline is in part a result of Gleason score reclassification during the same time period, we documented the potential impact of reclassification between 1992 and 2002 on clinical outcomes. Methods: A population-based cohort of 1858 men who were ≤75 years of age at diagnosis of prostate cancer in 1990–1992 was assembled retrospectively from the Connecticut Tumor Registry. Histology slides of the diagnostic prostate tissue were retrieved and reread in 2002–2004 by an experienced pathologist blinded to the original Gleason score readings. Prostate cancer mortality rates for the cohort calculated using the original Gleason score readings were compared with those calculated using the contemporary Gleason score readings. Statistical tests were two sided. Results: The contemporary Gleason score readings were statistically significantly higher than the original readings (mean score increased from 5.95 to 6.8; difference = 0.85, 95% confidence interval = 0.79 to 0.91; P
ISSN:0027-8874
1460-2105
DOI:10.1093/jnci/dji248