Inverse Stage Migration in Radical Prostatectomy—A Sustaining Phenomenon

Abstract

Objective: To investigate temporal trends in prostate cancer (PCa) radical prostatectomy (RP) candidates.Materials and Methods: Patients who underwent RP for PCa between January 2014 and December 2019 were identified form our institutional database. Trend analysis and logistic regression models assessed RP trends after stratification of PCa patients according to D'Amico classification and Gleason score. Patients with neoadjuvant androgen deprivation or radiotherapy prior to RP were excluded from the analysis.Results: Overall, 528 PCa patients that underwent RP were identified. Temporal trend analysis revealed a significant decrease in low-risk PCa patients from 17 to 9% (EAPC: −14.6%, p < 0.05) and GS6 PCa patients from 30 to 14% (EAPC: −17.6%, p < 0.01). This remained significant even after multivariable adjustment [low-risk PCa: (OR): 0.85, p < 0.05 and GS6 PCa: (OR): 0.79, p < 0.001]. Furthermore, a trend toward a higher proportion of intermediate-risk PCa undergoing RP was recorded.Conclusion: Our results confirm that inverse stage migration represents an ongoing phenomenon in a contemporary RP cohort in a European tertiary care PCa center. Our results demonstrate a significant decrease in the proportion of low-risk and GS6 PCa undergoing RP and a trend toward a higher proportion of intermediate-risk PCa patients undergoing RP. This indicates a more precise patient selection when it comes to selecting suitable candidates for definite surgical treatment with RP.

Effect of Neoadjuvant Chemotherapy on Complications, in-Hospital Mortality, Length of Stay and Total Hospital Costs in Bladder Cancer Patients Undergoing Radical Cystectomy

“…First, patient and RC-related characteristics, as well as outcome of interests were tabulated following stratification according to NAC status. Second, the estimated annual percentage change (EAPC) analyses were generated relying on the least squares linear regression methodology, as previously described [ 23 , 24 ]. EAPC analyses were weighted according to NIS methodology [ 13 ].…”

Twenty‐year trends in prostate cancer stage and grade migration in a large contemporary german radical prostatectomy cohort

“…For this reason, broad PSA testing was questioned and subsequently, a declining incidence of PCa was observed in the latest years, also within Germany. [2][3][4] On the other hand, when limiting PSA tests, the potential for inverse stage migration for PCa is evident. 5,6 In a recent report by Boehm et al, 7 as well as within another report by Van den Bergh et al, 8 the continuing trend of inverse stage and grade migration in PCa patients was confirmed, not only in Germany, but also throughout Europe.…”

“…This was specifically important when considering invasive treatment options, such as radical prostatectomy (RP). For this reason, broad PSA testing was questioned and subsequently, a declining incidence of PCa was observed in the latest years, also within Germany 2–4 . On the other hand, when limiting PSA tests, the potential for inverse stage migration for PCa is evident 5,6 .…”

Improvement in overall and cancer‐specific survival in contemporary, metastatic prostate cancer chemotherapy exposed patients

“…Finally, several hypotheses may be proposed to explain the differences between overall survival between contemporary and historical patients. Customarily, the differences between contemporary and historical patients consist of a more favorable stage, age, and other cancer characteristics that invariably result in better overall survival 19,20 . Our analyses demonstrated that this effect did not account for the chemotherapy benefit, as outlined above.…”