Stage and Grade Migration in Prostate Cancer Treated With Radical Prostatectomy in a Large German Multicenter Cohort.

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• Overdiagnosis and overtherapy in prostate cancer (PCa) necessitate careful treatment selection, particularly for low-risk cases.
• Decreased popularity of prostate-specific antigen (PSA) testing may influence cancer detection rates and stage at diagnosis.

Purpose of the Study:

• To evaluate stage and grade migration in patients treated with radical prostatectomy (RP).
• To analyze trends in prostate cancer diagnosis and risk stratification over time.

Main Methods:

• Analysis of data from 4842 patients undergoing RP between 2000 and 2019.
• Collection of patient data including age, PSA levels, biopsy and pathologic Gleason score, and clinical/pathologic stage.
• Evaluation of D'Amico risk groups and Gleason scores over different time periods.

Main Results:

• Significant grade migration towards higher Gleason scores observed.
• Proportion of biopsy Gleason sum ≤ 6 decreased from 45.8% to 20.6%.
• Proportion of low D'Amico risk patients decreased by approximately 50% (20.8% to 12.2%).
• Increase in non-organ-confined PCa and decrease in postoperative Gleason sum ≤ 6.

Conclusions:

• Data indicate significant preoperative grade and stage migration towards higher-grade prostate cancer in RP-treated patients.
• Observed changes may reflect improved patient selection for RP or a rise in prostate cancer severity.
• Potential implications for rising prostate cancer mortality and morbidity warrant further investigation.