title: Changes in indications and oncological outcomes of radical prostatectomy after 2000--data from 1268 Japanese patients treated with radical prostatectomy between 2000 and 2009.
abstract: OBJECTIVE
  The aim of the study was to characterize trends in indications for and oncological outcomes of radical prostatectomy after 2000.
  
  
  METHODS
  Data from 1268 patients undergoing radical prostatectomy without neoadjuvant therapy between 2000 and 2009 at four urological centers in Japan were retrospectively reviewed. Changes in age at radical prostatectomy, prostate-specific antigen level, biopsy Gleason score, clinical T stage, D'Amico risk classification, organ-confined disease and tumor volume in surgical specimens were analyzed over time.
  
  
  RESULTS
  The median age at radical prostatectomy decreased from 68 years in 2000-2 to 65 years in 2009 (P < 0.001). Approximately 63.3% of patients were ≥65 years old, and 31.4% of patients were ≥70 years old during the whole study period. The median prostate-specific antigen level decreased from 8.61 ng/ml in 2000-2 to 6.90 ng/ml in 2009 (P < 0.001). The rate of organ-confined disease increased from 52.8% in 2000-2 to 72.5% in 2009 (P = 0.004). The median tumor volume decreased from 1.70 cc in 2000-2 to 1.28 cc in 2009 (P = 0.017). The proportion of biopsy Gleason score 7 increased from 40.6% in 2000-2 to 60.1% in 2009 (P < 0.001), and the proportion of the intermediate-risk group increased from 39.5% in 2000-2 to 59.5% in 2009 (P < 0.001).
  
  
  CONCLUSIONS
  Age at radical prostatectomy for men with localized prostate cancer was higher in Japan than in the USA or Europe. Prostate-specific antigen, non-organ-confined disease and tumor volume decreased during the study period, whereas Gleason score 7 and intermediate-risk disease increased during the study period. This information enables comparison of outcomes between various treatments, between various geographic regions and between various time periods.
authors.affiliation: Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan. mitsuzuka@uro.med.tohoku.ac.jp
authors.forename: Koji
authors.initials: K
authors.lastname: Mitsuzuka
authors.forename: Takuya
authors.initials: T
authors.lastname: Koie
authors.forename: Shintaro
authors.initials: S
authors.lastname: Narita
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kaiho
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yoneyama
authors.forename: Norihiko
authors.initials: N
authors.lastname: Tsuchiya
authors.forename: Narihiko
authors.initials: N
authors.lastname: Kakoi
authors.forename: Sadafumi
authors.initials: S
authors.lastname: Kawamura
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Tochigi
authors.forename: Chikara
authors.initials: C
authors.lastname: Ohyama
authors.forename: Tomonori
authors.initials: T
authors.lastname: Habuchi
authors.forename: Takuhiro
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D015986:Confounding Factors, Epidemiologic; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000592:standards*; D011471:Prostatic Neoplasms / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D047368:Tumor Burden
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
keywords: age; indication; organ-confined disease; radical prostatectomy; time trend; tumor volume