MP42-19 TIME TRENDS IN CLINICOPATHOLOGIC DEMOGRAPHICS OF MEN WITH HIGH-RISK PROSTATE CANCER UNDERGOING RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Staging II1 Apr 2014MP42-19 TIME TRENDS IN CLINICOPATHOLOGIC DEMOGRAPHICS OF MEN WITH HIGH-RISK PROSTATE CANCER UNDERGOING RADICAL PROSTATECTOMY Sarah Psutka, R. Jeffrey Karnes, Suzanne Stewart, R. Houston Thompson, Matthew Tollefson, Carlson Rachel, Laureano Rangel, Eric Bergstralh, and Stephen Boorjian Sarah PsutkaSarah Psutka More articles by this author , R. Jeffrey KarnesR. Jeffrey Karnes More articles by this author , Suzanne StewartSuzanne Stewart More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Matthew TollefsonMatthew Tollefson More articles by this author , Carlson RachelCarlson Rachel More articles by this author , Laureano RangelLaureano Rangel More articles by this author , Eric BergstralhEric Bergstralh More articles by this author , and Stephen BoorjianStephen Boorjian More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1196AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives While a stage migration in prostate cancer has been well-recognized over the PSA era, temporal changes in the demographics of patients with high-risk disease (HrPC) continue to be defined. Herein, we report time trends in clinicopathologic features of men undergoing radical prostatectomy (RP) for HrPC. Methods We reviewed 18,299 patients treated with RP at Mayo Clinic between 1990-2011 to identify 2083 men with HrPC. HrPC was defined by NCCN criteria: biopsy Gleason score 8-10 and/or PSA > 20ng/mL and/or clinical stage ≥ T3. Patients were classified as early PSA era (1990-1997), mid PSA era (1998-2004), and late PSA era (2005-2011). Clinicopathologic demographics were compared using the Kruskal-Wallis and Pearson’s/Mantel-Haenszel Chi-square tests. Results The percentage of all patients undergoing RP in each era who were classified as high-risk decreased significantly over time, from 23.5% of RPs in the early PSA era to 10.5% in the mid PSA era to 9.5% the late PSA era (p<0.0001). Temporal trends in clinicopathologic features are depicted in the Table. More recent patients were significantly younger, with a lower PSA and lower clinical stage but with a higher biopsy Gleason score (all p<0.0001). The prevalence of patients with HrPC according to a single criteria significantly increased over time, from 78.6% to 83.2% to 87% (p=0.0001), while the prevalence of patients with two high-risk criteria decreased (19.3% vs 15.9% vs 11.9%; p=0.0007). Moreover, the rate of seminal vesicle invasion, positive surgical margins, and tumor volume significantly decreased, although the rate of Gleason 8-10 disease increased during the study period (all p<0.0001). Meanwhile, the rate of lymph node involvement was relatively stable from early (18.4%) to late PSA era (17.9%), as were the median number of lymph nodes removed (10 and 11, respectively, from early and late PSA eras). Conclusions HrPC represented a decreasing proportion of surgical cases over the course of the PSA era. Overall pathologic features have become more favorable in these men. Notably, an increasing percentage of patients are characterized as high-risk based on Gleason score, which may reflect prostate cancer stage migration and/or changes in Gleason grade assignment. Clinicopathologic characteristics of HrPC patients over time Variable Early PSA (n = 1066) Mid PSA (n = 471) Late PSA (n = 546) p-value Median age at RP (IQR) 66 (62, 70) 65 (58, 69) 64 (58, 69) < 0.0001 Median (IQR) preoperative PSA (ng/ml) 23.1 (10.3, 36) 13.4 (6.2, 25) 8.5 (5.3, 21.5) < 0.0001 Clinical tumor stage (%) (n=2056) cT1 158 (14.9) 159 (34.3 204 (38.5) < 0.0001 cT2 468 (44) 202 (43.5) 252 (47.5) cT3/4 436 (41.1) 103 (22.2) 74 (14) Biopsy Gleason score (%) (n=1751) bGS < = 6 328 (44.3) 117 (25.1) 39 (7.2) < 0.0001 bGS 7 196 (26.5) 99 (21.2) 115 (21.2) bGS 8 217 (29.3) 251 (53.7) 389 (71.6) Pathologic tumor stage pT2 374 (43) 237 (55.8) 262 (58.5) < 0.0001 pT3a 238 (27.4) 91 (21.4) 116 (25.9) pT3b 250 (28.7) 94 (22.1) 66 (14.7) pT4 8 (0.9) 3 (0.7) 4 (0.9) Pathologic Gleason score < = 6 427 (40.2) 89 (18.9) 29 (5.3) < 0.0001 7 465 (43.7) 180 (38.2) 243 (44.6) 8 - 10 171 (16.1) 202 (42.9) 273 (50.1) Positive Surgical Margins (%) 662 (62.1) 214 (45.4) 182 (33.3) < 0.0001 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e475-e476 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Sarah Psutka More articles by this author R. Jeffrey Karnes More articles by this author Suzanne Stewart More articles by this author R. Houston Thompson More articles by this author Matthew Tollefson More articles by this author Carlson Rachel More articles by this author Laureano Rangel More articles by this author Eric Bergstralh More articles by this author Stephen Boorjian More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...