Trends in Diagnosis of Gleason Score 2 Through 4 Prostate Cancer in the National Cancer Database, 1990-2013.

CONTEXT - The incidence of prostate cancer with Gleason scores 2 through 4 has been decreasing for decades, largely because of evolving criteria for Gleason scores, including the 2005 International Society of Urological Pathology recommendation that scores of 2 through 4 should rarely, if ever, be diagnosed based on needle biopsy. Whether trends in assigning Gleason scores 2 through 4 vary by facility type and patient characteristics is unknown. OBJECTIVE - To assess trends in prostate cancer grading among various categories of treatment facilities. DESIGN - Analyses of National Cancer Database records from 1990 through 2013 for 434 612 prostate cancers diagnosed by core needle biopsy, including multivariable regression for 106 331 patients with clinical T1c disease diagnosed from 2004 through 2013. RESULTS - The proportion of prostate core needle biopsies with Gleason scores 2 through 4 declined from 11 476 of 53 850 (21.3%) (1990-1994) to 96 of 43 566 (0.2%) (2010-2013). The proportions of American Joint Committee on Cancer category T1c needle biopsies assigned Gleason scores 2 through 4 were 416 of 12 796 (3.3%) and 9 of 7194 (0.1%) during 2004 and 2013, respectively. Declines occurred earliest at National Cancer Institute-designated programs and latest at community programs. A multivariable logistic model adjusting for patient demographic and clinical variables and restricted to T1c cancers diagnosed in needle biopsies from 2004 through 2013 showed that facility type is independently associated with the likelihood of cancers in such specimens being assigned Gleason scores of 2 through 4, with community centers having a statistically significant odds ratio of 5.99 relative to National Cancer Institute-designated centers. CONCLUSIONS - These results strongly suggest differences in Gleason grading by pathologists practicing in different facility categories and variations in their promptness of adopting International Society of Urological Pathology recommendations.

[1]  James A Hanley,et al.  Prostate cancer and the Will Rogers phenomenon. , 2005, Journal of the National Cancer Institute.

[2]  Alan W Partin,et al.  Prognostic Gleason grade grouping: data based on the modified Gleason scoring system , 2013, BJU international.

[3]  J. Epstein,et al.  Interobserver reproducibility of Gleason grading of prostatic carcinoma: general pathologist. , 2001, Human pathology.

[4]  Brian S Caffo,et al.  Practical marginalized multilevel models , 2013, Stat.

[5]  J. Epstein.  An update of the Gleason grading system. , 2010, The Journal of urology.

[6]  I. Thompson,et al.  Stage migration and grade inflation in prostate cancer: Will Rogers meets Garrison Keillor. , 2005, Journal of the National Cancer Institute.

[7]  P. Stattin,et al.  Gleason inflation 1998–2011: a registry study of 97 168 men , 2015, BJU international.

[8]  J. Cuzick,et al.  Major shifts in the treatment and prognosis of prostate cancer due to changes in pathological diagnosis and grading , 2007, BJU international.

[9]  Keith E. Volmar,et al.  Q-Probes studies in anatomic pathology: quality improvement through targeted benchmarking. , 2014, Archives of pathology & laboratory medicine.

[10]  K. Grigor,et al.  Trends in reporting Gleason score 1991 to 2001: changes in the pathologist's practice. , 2005, European urology.

[11]  A. Jemal,et al.  Variations in cancer centers’ use of cytology for the diagnosis of unresectable pancreatic cancer in the National Cancer Data Base , 2016, Cancer cytopathology.

[12]  A. Jemal,et al.  Variations in cancer centers' use of cytology for the diagnosis of small cell lung carcinoma in the National Cancer Data Base , 2016, Cancer cytopathology.

[13]  S. Wooding,et al.  The answer is 17 years, what is the question: understanding time lags in translational research , 2011, Journal of the Royal Society of Medicine.

[14]  Gleason Df.  Classification of prostatic carcinomas. , 1966 .

[15]  S. Piantadosi,et al.  Correlation of prostate needle biopsy and radical prostatectomy Gleason grade in academic and community settings. , 1997, The American journal of surgical pathology.

[16]  Stephen S Raab,et al.  Quality in Cancer Diagnosis , 2010, CA: a cancer journal for clinicians.

[17]  Peter McCulloch,et al.  Understanding regional variation in the use of surgery , 2014 .

[18]  L. Shulman,et al.  Building Data Infrastructure to Evaluate and Improve Quality: The National Cancer Data Base and the Commission on Cancer's Quality Improvement Programs. , 2015, Journal of oncology practice.

[19]  J. Epstein,et al.  Gleason score 2-4 adenocarcinoma of the prostate on needle biopsy: a diagnosis that should not be made. , 2000, The American journal of surgical pathology.

[20]  L. Egevad,et al.  The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma , 2005, The American journal of surgical pathology.

[21]  L. Egevad,et al.  The significance of modified Gleason grading of prostatic carcinoma in biopsy and radical prostatectomy specimens , 2006, Virchows Archiv.

[22]  A. Stewart,et al.  Comparison of Cases Captured in the National Cancer Data Base with Those in Population-based Central Cancer Registries , 2013, Annals of surgical oncology.

[23]  J. Epstein,et al.  A contemporary study correlating prostate needle biopsy and radical prostatectomy Gleason score. , 2008, The Journal of urology.

[24]  V. Master,et al.  Age and Grade Trends in Prostate Cancer (1974–2003): A Surveillance, Epidemiology, and End Results Registry Analysis , 2008, American journal of clinical oncology.

[25]  L. Egevad,et al.  A Contemporary Prostate Cancer Grading System: A Validated Alternative to the Gleason Score. , 2016, European urology.

[26]  Lars Egevad,et al.  A contemporary update on pathology reporting for prostate cancer: biopsy and radical prostatectomy specimens. , 2012, European urology.

[27]  K. Cronin,et al.  Validation of prostate‐specific antigen laboratory values recorded in Surveillance, Epidemiology, and End Results registries , 2016, Cancer.

[28]  D. Berwick.  Disseminating innovations in health care. , 2003, JAMA.

[29]  B. Delahunt,et al.  The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System , 2015, The American journal of surgical pathology.

[30]  C. Ko,et al.  Using the NCDB for cancer care improvement: An introduction to available quality assessment tools , 2009, Journal of surgical oncology.

[31]  R. Ho,et al.  The National Cancer Data Base report on longitudinal observations on prostate cancer , 1996, Cancer.