Impact of stage migration and practice changes on high risk prostate cancer: Results from patients treated with radical prostatectomy over the last two decades - Abstract

BACKGROUND: Phenotype of prostate cancer at diagnosis has changed through the years.

We aim to evaluate the impact of year of surgery on clinical, pathologic and oncologic outcomes of high-risk prostate cancer patients.

PATIENTS AND METHODS: We evaluated 1,033 clinically high-risk patients, defined as the presence of at least one of the following risk factors: pre-operative prostate specific antigen (PSA) level >20 ng/ml, and/or clinical stage ≥T3, and/or biopsy Gleason score ≥8. Patients were treated between 1990 and 2013 at a single Institution. Year-per-year trends of clinical and pathologic characteristics were examined. Multivariable Cox regression analysis was used to test the relationship between year of surgery and oncologic outcomes.

RESULTS: We observed a decrease over time in the proportion of high-risk patients with a pre-operative PSA level >20 ng/ml or clinical stage cT3. An opposite trend was seen for biopsy Gleason score ≥8. We observed a considerable increase in the median number of lymph nodes removed that was associated with an increased rate of LNI. At multivariable Cox regression analysis, year of surgery was associated with a reduced risk of biochemical recurrence (HR per 5-year: 0.90; 95% CI: 0.84-0.96; p=0.01) and distant metastasis (HR per 5-year: 0.91; 95% CI: 0.83-0.99; p=0.039), after adjusting for age, pre-operative PSA, pathologic stage, lymph node invasion, surgical margin status, and pathological Gleason score.

CONCLUSIONS: In this single center study, an increased diagnosis of localized and less extensive high-grade prostate cancer was observed over the last two decades. High-risk patients selected for radical prostatectomy showed better cancer control over time. Better definitions of what constitutes high-risk prostate cancer among contemporary patients are needed.

Written by:
Fossati N, Passoni NM, Moschini M, Gandaglia G, Larcher A, Freschi M, Guazzoni G, Sjoberg DD, Vickers AJ, Montorsi F, Briganti A.   Are you the author?
Division of Oncology / Unit of Urology; URI, IRCCS Ospedale San Raffaele, Milan, Italy; Dept. of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.

Reference: BJU Int. 2015 Mar 17. Epub ahead of print.
doi: 10.1111/bju.13125

PubMed Abstract
PMID: 25787671 Prostate Cancer Section