Inverse Stage Migration in Radical Prostatectomy-A Sustaining Phenomenon.

Benedikt Hoeh,Peter Wild,Jens Köllermann,Luis A Kluth,Matthias Müller,Felix Preisser,Frederik C Roos,Maria-Noemi Welte,Felix K H Chun,Andreas Becker,Clara Humke,Mike Wenzel,Philipp Mandel

doi:10.3389/fsurg.2021.612813

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.

Highlights

After the introduction of prostate-specific antigen (PSA) and its use for screening and early detection of prostate cancer (PCa), changes of disease characteristics in PCa patients have been recorded
After stratification according to the D’Amico classification, 60 (11.4%) patients were defined as low-risk, 310 (58.7%) as intermediate-risk, and 158 (29.9%) as high-risk PCa patients
After stratification of patients according to the initial histopathology, 103 (19.5%) patients harbored a biopsy of GS6, 318 (60.0%) patients harbored a biopsy of GS7, and 107 (20.0%) patients harbored a biopsy of GS8–10

Summary

Introduction

After the introduction of prostate-specific antigen (PSA) and its use for screening and early detection of prostate cancer (PCa), changes of disease characteristics in PCa patients have been recorded. Several studies reported an increased prevalence of localized PCa patients with a migration toward earlier-stage cancer being diagnosed in younger patients with lower preoperative PSA values as well as an increase in the proportion of patients with organ confined disease at final pathology after radical prostatectomy (RP) [1,2,3,4]. With the growing popularity of multimodal treatment strategies for advanced and high-risk PCa, a study published in 2008 firstly demonstrated an inverse trend toward locally advanced tumors in a multinational cohort of patients treated with RP [9] This trend—known as inverse stage migration—was accompanied by an increased rate of patients harboring high-grade PCa at clinical and histopathological characteristics and was confirmed in various studies [10,11,12]

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Results

Discussion

Conclusion