With the widespread use of screening for prostate-specific antigen (PSA), T1c prostate cancer has shown a marked increase in Western countries. We reviewed the trends in clinical stage migration and the changes in the clinical characteristics for patients with prostate cancer in Korea, and we compared these values with those of Western men.

Between 1997 and 2006, 758 men (mean age: 68.6 years) were diagnosed with prostate cancer at our institution. According to the diagnostic period, the patients were divided into 3 groups (the 1997–2000, 2001–2003 and 2004–2006 groups) for comparative analysis of the clinical stage, the serum PSA level and the biopsy Gleason score.

The proportion of clinically localized prostate cancer significantly increased by the period (56.8%, 62.5% and 75.4%, respectively; p＜0.001) with that of metastatic disease showing a decreasing according to groups (40.0%, 27.5% and 17.6%, respectively; p＜0.001). For localized disease, T1c cancers also increased from 26.4% to 19.2% to 31.6% (p=0.002), respectively. The median serum PSA level at diagnosis decreased from 34.5 ng/ml to 16.6ng/ml to 10.8ng/ml (p＜0.001), respectively, with the proportion of patients with a PSA level≤10ng/ml increasing significantly (19.2%, 33.3% and 47.7%, respectively; p＜0.001). Although the proportion of biopsy Gleason scores that were 8–10 decreased from 71.2% to 50.2% to 38.3%, respectively, it still comprised 20.8% of the T1c cancers and 22.8% of the cancers with a PSA≤10ng/ml in the last period, and these values were significantly higher than those in the Western reports.

Downward migration of the clinical stage along with decreases for the serum PSA level and biopsy Gleason score were evident in Korean men. However, the proportion of T1c cancer was still lower than that in the Western series and the fraction of Gleason score 8–10 cancer was distinctively high. We believe this mandates establishing PSA screening programs and administering vigorous management.