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Changes in Gleason Scores for Prostate Cancer
  1. Jorge Ramos, DO*,
  2. Edward Uchio, MD†‡,
  3. Mihaela Aslan, PhD,
  4. John Concato, MD, MS, MPH*§∥
  1. From the Departments of *Medicine, and †Surgery (Urology), Yale University School of Medicine, New Haven, CT; ‡Surgical Service (Urology), §Clinical Epidemiology Research Center, and ∥Medical Service, VA Connecticut Healthcare System, West Haven, CT.
  1. Received October 13, 2009, and in revised form December 11, 2009.
  2. Accepted for publication January 5, 2010.
  3. Reprints: John Concato, MD, MS, MPH, VA Connecticut Healthcare System, Clinical Epidemiology Research Center (151B), 950 Campbell Ave, West Haven, CT 06516. E-mail: john.concato{at}yale.edu.

What Should We Expect From a Measurement?

Abstract

Background Men diagnosed with prostate cancer receive therapy based on various clinical characteristics, including the Gleason score, a measurement (range, 2-10) describing a tumor's histological appearance. An upward shift has occurred in the distribution of Gleason scores during the past decade; this change was influenced by reports suggesting that lower scores (range, 2-4) should not be assigned to biopsy specimens.

Methods We (1) compared Gleason scores from 1994-1995 and 2004-2005 at the same institution, (2) reviewed representative articles examining changes in Gleason scores during the last 2 decades, and (3) assessed the implications of a change in histological measurements.

Results Among men diagnosed with prostate cancer at VA Connecticut, Gleason scores 2 to 4 were reported for 11.4% (19/167) of specimens in 1994-1995 but only 0.4% (1/260) of specimens in 2004-2005; this difference persisted after adjusting for age, clinical stage, and prostate-specific antigen (P < 0.001). Similar results were evident in previous publications on this topic. A change in criteria for a clinical measurement may have unintended consequences, including problems of inconsistency across "time" and "place."

Conclusions Recent shifts in Gleason scores have led to fewer patients being diagnosed with low-grade prostate cancer; this change can have adverse impacts in clinical care and research.

Key Words
  • prostate cancer
  • histology
  • Gleason score
  • measurements
  • patient-oriented research
  • clinical epidemiology

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