Background: The aim of this study was to verify the described inverse stage migration after radical prostatectomy by a tertiary care center in 2011 in a national collective.
Materials and methods: Data from 10,323 patients with prostate cancer (PCa), who had radical prostatectomy between 1998 and 2012, were analyzed regarding prostate-specific antigen (PSA) and age at diagnosis, T stage, and Gleason score. A trend over time was determined by using the Jonckheere-Terpstra test.
Results: Median age at surgery was 65 years (1998: 63.7; 2012: 66.5). The proportion of low-risk tumors decreased from 39% in 2005 to 25% in 2012, while the intermediate-risk tumors showed a continuous increase since 1998 from 35 to 52% in 2012. The proportion of patients with a Gleason score ≤ 6 decreased from 60% in 1998 to 25 % in 2012. The Gleason score groups 7a and 7b, however, increased from 12 to 46, % and 12 to 19%, respectively. The proportion of tumors with a Gleason score of 8-10 decreased from 16 to 10%. The proportion of organ-confined prostate cancer increased from 1998 to 2007 continuously from 57 to 73%. Since 2007 the proportion dropped to 64%.
Conclusions: In this national population a trend towards inverse stage migration can be noted. Both the increase in Gleason score ≥ 6 and intermediate-risk tumors can be explained by the modification of the Gleason score. The tendency towards higher age and nonorgan-confined cancers at surgery could be dependent of the growing recognition of radical prostatectomy as a treatment for locally advanced prostate cancer, on the one hand, and the increase of alternative treatments for low-risk cancers, on the other hand.
Keywords: Gleason Score; Jonckheere-Terpstra Test; Lymph node staging; Neoplasm staging; Prostate-specific antigen.