title: [Patients with prostate cancer after radical prostatectomy: Stage migration and changes in tumor characteristics from 1998-2012].
abstract: BACKGROUND
  The aim of this study was to verify the described inverse stage migration after radical prostatectomy by a tertiary care center in 2011 in a national collective.
  
  
  METHODS
  Data from 10,323 patients with prostate cancer (PCa), who had radical prostatectomy between 1998 and 2012, were analyzed regarding prostate-specific antigen (PSA) and age at diagnosis, T stage, and Gleason score. A trend over time was determined by using the Jonckheere-Terpstra test.
  
  
  RESULTS
  Median age at surgery was 65 years (1998: 63.7; 2012: 66.5). The proportion of low-risk tumors decreased from 39% in 2005 to 25% in 2012, while the intermediate-risk tumors showed a continuous increase since 1998 from 35 to 52% in 2012. The proportion of patients with a Gleason score ≤ 6 decreased from 60% in 1998 to 25 % in 2012. The Gleason score groups 7a and 7b, however, increased from 12 to 46, % and 12 to 19%, respectively. The proportion of tumors with a Gleason score of 8-10 decreased from 16 to 10%. The proportion of organ-confined prostate cancer increased from 1998 to 2007 continuously from 57 to 73%. Since 2007 the proportion dropped to 64%.
  
  
  CONCLUSIONS
  In this national population a trend towards inverse stage migration can be noted. Both the increase in Gleason score ≥ 6 and intermediate-risk tumors can be explained by the modification of the Gleason score. The tendency towards higher age and nonorgan-confined cancers at surgery could be dependent of the growing recognition of radical prostatectomy as a treatment for locally advanced prostate cancer, on the one hand, and the increase of alternative treatments for low-risk cancers, on the other hand.
authors.affiliation: Urologische Klinik, Klinikum rechts der Isar der TU München, Ismaningerstraße 22, 81675, München, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Walther
authors.affiliation: Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm, Ulm, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Kron
authors.affiliation: Urologische Klinik, Klinikum rechts der Isar der TU München, Ismaningerstraße 22, 81675, München, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Klorek
authors.affiliation: Urologische Klinik, Klinikum rechts der Isar der TU München, Ismaningerstraße 22, 81675, München, Deutschland.
authors.forename: J E
authors.initials: JE
authors.lastname: Gschwend
authors.affiliation: Urologische Klinik, Klinikum rechts der Isar der TU München, Ismaningerstraße 22, 81675, München, Deutschland. kathleen.herkommer@tum.de.
authors.forename: K
authors.initials: K
authors.lastname: Herkommer
mesh_terms: D000368:Aged; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D012307:Risk Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Gleason Score; Jonckheere-Terpstra Test; Lymph node staging; Neoplasm staging; Prostate-specific antigen