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.
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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.
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 %.
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.
Der Urologe. Ausg. A. 2015 Oct 16 [Epub ahead of print]
A Walther, M Kron, T Klorek, J E Gschwend, K Herkommer
Urologische Klinik, Klinikum rechts der Isar der TU München, Ismaningerstraße 22, 81675, München, Deutschland. , Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm, Ulm, Deutschland. , Urologische Klinik, Klinikum rechts der Isar der TU München, Ismaningerstraße 22, 81675, München, Deutschland. , Urologische Klinik, Klinikum rechts der Isar der TU München, Ismaningerstraße 22, 81675, München, Deutschland. , Urologische Klinik, Klinikum rechts der Isar der TU München, Ismaningerstraße 22, 81675, München, Deutschland.