Journal List > Korean J Urol > v.48(6) > 1004932

Song, Song, and Ahn: Continuing Trends of the Clinical Parameter Migration in Patients with Prostate Cancer in Korea

Abstract

Purpose

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.

Materials and Methods

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.

Results

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.

Conclusions

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.

References

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Fig. 1.
The clinical stage according to diagnostic period.
kju-48-574f1.tif
Fig. 2.
Correlation between serum the prostate-specific antigen (PSA) level and the prostate biopsy Gleason score.
kju-48-574f2.tif
Table 1.
The clinical and histological changes according to the diagnostic period
  1997–2000 2001–2003 2004–2006 1997–2006 p-value
No. of cases (%) 125 (16.5) 291 (38.4) 342 (45.1) 758 (100.0)  
 Age (years)          
  Mean 68.8 69.3 68.0 68.6 0.15∗
  Median 69.0 70.0 68.0 69.0  
Clinical stage (%)          
  Localized 71 (56.8) 182 (62.5) 258 (75.4) 511 (67.4)  
  Locally advanced 6 (4.8) 37 (12.7) 31 (9.1) 74 (9.8) <0.001
  Metastatic 48 (38.4) 72 (24.7) 53 (15.5) 173 (22.8)  
Serum PSA level (ng/ml)          
  Mean 352.3 105.1 96.8 142.1  
  Median 34.5 16.6 10.8 14.8 <0.001
  10 or less 24 (19.2) 97 (33.3) 163 (47.7) 284 (37.5)  
  10.1–20 28 (22.4) 59 (20.3) 67 (19.6) 154 (20.3) <0.001
  Greater than 20 73 (58.4) 135 (46.4) 112 (32.7) 320 (42.2)  
Biopsy gleason score (%)          
2–6 15 (12.0) 52 (17.9) 110 (32.2) 177 (23.4)  
7 21 (16.8) 93 (32.0) 101 (29.5) 215 (28.4) <0.001
8–10 89 (71.2) 146 (50.2) 131 (38.3) 366 (48.3)  

PSA: prostate-specific antigen.

: ANOVA

: chi-square test

Table 2.
The clinical and histological changes of clinically localized prostate cancer
  1997–2000 2001–2003 2004–2006 1997–2006 p-value
No. of cases (%) 71 (13.9) 182 (35.8) 256 (50.3) 509 (100.0)  
 Age (years)          
  Mean 68.4 69.0 67.0 67.9 0.035
  Median 69.0 69.5 67.0 68.0  
Serum PSA level (ng/ml)          
  Mean 31.5 20.2 20.0 21.7  
  Median 13.6 11.5 8.8 10.3 0.381
Biopsy gleason score (%)          
  2–6 13 (18.3) 45 (24.7) 100 (39.1) 158 (31.0)  
  7 15 (21.1) 79 (43.4) 84 (32.8) 178 (35.0) <0.001
8–10 43 (60.6) 58 (31.9) 72 (28.1) 173 (34.0)  

PSA: prostate-specific antigen.

: ANOVA

: chi-square test

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