Trends in risk classification at diagnosis and choice of primary therapy for prostate cancer: An analysis of 10839 patients from the Nara Urological Research and Treatment Group registry between 2004 and 2015.

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To evaluate trends in risk classification at diagnosis and choice of primary therapy in patients diagnosed with prostate cancer. This retrospective study included 10839 patients who were newly diagnosed with prostate cancer between 2004 and 2015 at 23 Japanese institutions. Risk classification and primary therapies between 2004 and 2015 were evaluated. The trends in risk classification and primary therapy were evaluated using chi-squared tests for trend during four periods (2004-2006; 2007-2009; 2010-2012; and 2013-2015). Binary logistic analysis was used to evaluate the extent to which factors such as age, risk classification, and institution influenced primary therapy choice in the 2013-2015 cohort. The number of patients with very-low or low-risk classification (P<0.001) and metastasis (P=0.04) decreased and the number with intermediate-risk classification (P<0.001) increased during the four periods. A tendency to choose radical prostatectomy as primary therapy for prostate cancer was not observed during the four periods (P=0.90). The number of patients who chose radiation therapy (P<0.001) and active surveillance/watchful waiting (P<0.001) as primary therapies increased during the four periods and the number of patients who chose androgen deprivation therapy (P<0.001) decreased. Age, institution, and risk classification significantly influenced primary therapy choice. We have shown the trends in risk classification of prostate cancer and primary therapy choices between 2004 and 2015 in Japan. Age, institution, and risk classification significantly influenced the decision on primary therapy for prostate cancer.