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

Abstract

Background: A trend towards inverse stage migration in prostate cancer (PCa) was reported. However, previous analyses did not take into account potential differences in sampling strategies (number of biopsy cores), which might have confounded these reports.Material and Methods: Within our single-institutional database we identified PCa patients treated with radical prostatectomy (RP) between 2000 and 2020 (n = 21,646). We calculated the estimated annual percentage change (EAPC) for D'Amico risk groups, biopsy Gleason Grade Group (GGG), PSA and cT stage as well as postoperative RP GGG and pT stage relying on log linear regression methodology. Subsequently, we repeated the analyses after adjustment for number of cores obtained at biopsy. Results: Absolute rates of D'Amico low risk decreased (−30.1%), while intermediate and high risk increased (+21.2% and +9.0%, respectively). Rates of GGG I decreased (−50.0%), while GGG II-V increased, with the largest increase in GGG II (+22.5%). This trend, albeit less pronounced, was also recorded after adjusted EAPC analyses (p < .05). Specifically, EAPC values for D'Amico low vs intermediate vs high risk were −1.07%, +0.37%, +0.45%, respectively, and EAPC values for GGG ranged between −0.71% (GGG I) and +0.80% (GGG IV). Finally, an increase in ≥cT2 (EAPC: +3.16%) was displayed (all p < .001). These trends were confirmed in EAPC calculations in RP GGG and pT stages (p < .001). Conclusion:Our findings confirm the trend towards less frequent treatment of low risk PCa and more frequent treatment of high risk PCa, also after adjustment for number of biopsy cores.

Adverse upgrading and/or upstaging in contemporary low-risk prostate cancer patients

“…Last but not least, SEER represents a retrospective data repository. Although, no prospective trial addressed the end points of the current study, several large institutional databases relied on prospective gathered data on biopsy and pathologic findings 33 . Such databases are undoubtedly better.…”

Increased risk of postoperative in‐hospital complications after radical prostatectomy in patients with prior organ transplant

“…Finally, differences in RP rates over time in transplant patients were estimated with estimated annual percent change (EAPC) that relied on log-linear methodology, as previously reported. [19][20][21] All tests were two sided with a level of significance set at p < 0.05 and R software environment for statistical computing and graphics (version 3.4.3) was used for all analyses.…”

Low‐grade prostate cancer should still be labelled cancer

“…While the percentage of GS6 cases undergoing prostatectomy is difficult to measure directly, it can be inferred that this has declined. Large cohort studies have shown a reduction in the prevalence of GS6 cancer at prostatectomy in the United States to one-third of its prior incidence (to 10%) [6], and in Europe to one-half its prior incidence (to 8.3%) [7]. Renaming GS6 cancer as non-cancer is unlikely to mitigate overtreatment while discouraging a subset of patients from undergoing active surveillance, including multiparametric MRI and repeat biopsy.…”