Skip Navigation LinksHome > March 2011 - Volume 18 - Issue 2 > Prostate Cancer Staging and Grading at Radical Prostatectomy...
Advances in Anatomic Pathology:
doi: 10.1097/PAP.0b013e31820cb506
Review Articles

Prostate Cancer Staging and Grading at Radical Prostatectomy Over Time

Falzarano, Sara Moscovita MD*,†; Magi-Galluzzi, Cristina MD, PhD*,‡

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Prostate-specific antigen (PSA) testing has been associated with a sharp increase in prostate cancer (PCA) detection after its introduction in the late 1980s. Since its launch and its implementation as diagnostic test in 1994, temporal patterns in patients' age and serum PSA level at presentation have changed, with younger patients being diagnosed at lower PSA cutoff levels. Many studies suggest that PSA screening has resulted in a profound downward migration in clinical and pathologic stage of newly diagnosed PCA, although the effect has slowed in the most recent years. The impact on tumor grading is less clear. Histologic grading of PCA, based on the Gleason system, is predictive of the biological behavior and prognosis of the tumor. If tumor progresses from low grade to high grade, the early detection would lead to a higher percentage of low-grade disease diagnosed over time. However, published data suggest that tumor grade shifts have occurred over time and are unlikely to be attributable to changes in tumor biology, but rather to changes in practice with respect to Gleason grading. This review will address PCA staging and grading trends from the pre-PSA era to the present time with emphasis on the potential role played by changes in clinical and pathologic practice.

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.


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