Inverse stage migration in patients undergoing radical prostatectomy: results of 8916 European patients treated within the last decade.
OBJECTIVE
• To investigate the stage migration patterns during the last decade in European men treated with radical prostatectomy (RP).


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.
Martiniclinic, Prostate Cancer Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Lars.Budaeus@gmail.com
Lars
L
Budäus
Jan
J
Spethmann
Hendrik
H
Isbarn
Jan
J
Schmitges
Laura
L
Beesch
Alexander
A
Haese
Georg
G
Salomon
Thorsten
T
Schlomm
Margit
M
Fisch
Hans
H
Heinzer
Hartwig
H
Huland
Markus
M
Graefen
Thomas
T
Steuber
D000328:Adult; D000368:Aged; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery
D017430:Prostate-Specific Antigen