A Walther1, M Kron2, T Klorek1, J E Gschwend1, K Herkommer3. 1. Urologische Klinik, Klinikum rechts der Isar der TU München, Ismaningerstraße 22, 81675, München, Deutschland. 2. Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm, Ulm, Deutschland. 3. Urologische Klinik, Klinikum rechts der Isar der TU München, Ismaningerstraße 22, 81675, München, Deutschland. kathleen.herkommer@tum.de.
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. MATERIALS AND 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.
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. MATERIALS AND 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.
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