© 2005 Oxford University Press
EDITORIAL |
Stage Migration and Grade Inflation in Prostate Cancer: Will Rogers Meets Garrison Keillor
Affiliations of authors: Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX (IMT, EC-H); Department of Pathology, University of Colorado Health Science Center, Denver, CO (MSL)
Correspondence to: Ian M. Thompson, MD, Department of Urology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229 (e-mail: thompsoni@uthscsa.edu).
| The first 150 words of the full text of this article appear below. |
A phenomenon described by several previous investigators—an upward drift in assigned Gleason grade to prostate cancer—is elegantly addressed in the article by Albertsen and colleagues in this issue of the Journal (1). The authors asked the question: are prostate cancers currently more aggressive, or are we just labeling them as more aggressive? Comparing initial biopsy Gleason grades from a decade ago with a contemporary Gleason grade assessment of the same samples, the authors made two important observations. First, there was a substantial shift to higher tumor grades with contemporary evaluation. Second, when survival was stratified by Gleason score, all groups of patients appeared to have improved outcomes, merely by rereading of the biopsy slides and the assignment of a new, contemporary Gleason score.
A similar phenomenon could be the Will Rogers effect, a term that was first coined by Feinstein and colleagues (2); this