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Discussion of the influence of PSA
testing on "stage migration" - finding PCa at an earlier stage.
(November 2002)
D'Amico and Ung present the data from a
Boston consortium in Urology, September 2002,to show that "early" PC is
becoming "earlier" (stage migration) due to PSA screening and current
diagnostic techniques. They are among many who report the same trend. They
report the preoperative characteristics of 1059 patients with clinically
localized PC studied in three time periods, '89-'92,'93-'96,'97-2000 and
show a decreasing trend in initial PSA, clinical stage, and biopsy Gleason
scores. Of interest to this discussion is the D'Amico data, which may be
compared to the findings in the Swedish study in which 75% of men were T2.
In contrast, in the D'Amico study 81.7% were T1C and only 17.3% were any
T2 stage. Only 31% of PSA's were >10. It's interesting that the Gleason
scores 6 were similar in the Swediah and D'Amico studies i.e. 60% versus
68%. But with respect to organ confined disease authors such as Catalona
has argue that screening doubles the proportion of PCs that are organ
confined versus those that are diagnoses by digital rectal exam.
Bottom Line: PSA screening finds disease at an earlier stage and this
implies greater curability.
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