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Impact of stage migration and practice changes on high‐risk prostate cancer: results from patients treated with radical prostatectomy over the last two decades
Author(s) -
Fossati Nicola,
Passoni Niccolò M.,
Moschini Marco,
Gandaglia Giorgio,
Larcher Alessandro,
Freschi Massimo,
Guazzoni Giorgio,
Sjoberg Daniel D.,
Vickers Andrew J.,
Montorsi Francesco,
Briganti Alberto
Publication year - 2016
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13125
Subject(s) - medicine , prostatectomy , prostate cancer , stage (stratigraphy) , hazard ratio , proportional hazards model , confidence interval , surgical margin , pathological , prostate specific antigen , prostate , urology , biopsy , biochemical recurrence , t stage , cancer , oncology , biology , paleontology
Objective To evaluate the impact of year of surgery on clinical, pathological and oncological outcomes of patients with high‐risk prostate cancer. Patients and Methods We evaluated 1 033 patients with clinically high‐risk prostate cancer, defined as the presence of at least one of the following risk factors: preoperative prostate‐specific antigen ( PSA ) level >20 ng/mL, and/or clinical stage ≥T3, and/or biopsy Gleason score ≥8. Patients were treated between 1990 and 2013 at a single institution. The year‐by‐year trends in clinical and pathological characteristics were examined. Multivariable Cox regression analysis was used to test the relationship between year of surgery and oncological outcomes. Results We observed a decrease over time in the proportion of patients with high‐risk disease (preoperative PSA >20 ng/mL or clinical stage cT 3). A trend in the opposite direction was seen for biopsy Gleason score ≥8 tumours. We observed a considerable increase in the median number of lymph nodes removed, which was associated with an increased rate of lymph node invasion ( LNI ). On multivariable Cox regression analysis, year of surgery was associated with a reduced risk of biochemical recurrence (hazard ratio [ HR ] per 5‐year interval 0.90, 95% confidence interval [ CI ] 0.84–0.96; P = 0.01) and distant metastasis ( HR per 5‐year interval 0.91, 95% CI 0.83–0.99; P = 0.039), after adjusting for age, preoperative PSA , pathological stage, LNI , surgical margin status, and pathological Gleason score. Conclusions In this single‐centre study, an increased diagnosis of localized and less extensive high‐grade prostate cancer was observed over the last two decades. Patients with high‐risk disease who were selected for radical prostatectomy showed better cancer control over time. Better definitions of what constitutes high‐risk prostate cancer among contemporary patients are needed.