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Keywords:

  • radical prostatectomy;
  • PSA;
  • stage migration;
  • grade migration

Study Type – Therapy (case series)

Level of Evidence 4

What’s known on the subject? and What does the study add?

The widespread use of PSA testing resulted in a stage migration towards clinical organ-confined prostate cancers at diagnosis during the last decade. However, our study of a large cohort demonstrates an increasing proportion of patients with non-organ confined cancers after radical prostatectomy. These findings may be related to the introduction of new, non-established treatment options for low-risk prostate cancer patients during the last years and the growing adoption of RP in a multimodal treatment setting for locally advanced tumours.

OBJECTIVE

• To investigate the stage migration patterns during the last decade in European men treated with radical prostatectomy (RP).

PATIENTS AND METHODS

• Between 2000 and 2009, RP was performed in 8916 patients at a single European tertiary-care institution.

• Age at diagnosis, clinical and pathological data were prospectively collected, and trends and proportions of preoperative and pathological findings were analysed over time.

RESULTS

• The median (mean) age of patients increased from 62 (62) to 63 (65) years between 2000 and 2009 (P < 0.001).

• When patients were stratified based on their clinical findings according to the D’Amico risk groups for disease progression, the proportion of low-risk patients dropped from 66% in 2004 to 35% (P= 0.016) in the final year of the study period.

• Similarly, histopathological evaluation of RP specimens showed a decrease of favourable disease (organ confinement and Gleason 3 + 3 grade) from 53 to 17% (P= 0.008).

• This trend was accompanied by an increase in the number of patients with non-organ-confined prostate cancer (PCa) from 19% in 2003 to 33% in 2009 (P= 0.008).

• The restriction of the analyses in the present study to a single tertiary-care centre could limit the generalizeability of the results.

CONCLUSIONS

• During the last decade, we observed an inverse stage migration trend in those European patients with PCa who were treated with RP.

• The recorded increase in patients with non-organ-confined disease after RP could be related to changes in patient selection and the growing adoption of RP in multimodal treatment settings for locally advanced tumours as well as the availability of new treatment alternatives for low-risk disease.