Inverse Stage Migration in Radical Prostatectomy-A Sustaining Phenomenon

Area of Science:

• Urology
• Oncology
• Surgical Oncology

Background:

• Radical prostatectomy (RP) is a primary treatment for prostate cancer (PCa).
• Understanding temporal trends in patient selection for RP is crucial for optimizing treatment strategies.
• Changes in diagnostic criteria and treatment guidelines may influence the characteristics of patients undergoing RP.

Purpose of the Study:

• To analyze temporal trends in the characteristics of patients undergoing radical prostatectomy (RP) for prostate cancer (PCa).
• To investigate shifts in risk stratification (D'Amico classification, Gleason score) among PCa patients selected for RP over time.

Main Methods:

• Retrospective analysis of 528 patients who underwent RP for PCa between January 2014 and December 2019.
• Trend analysis and logistic regression models were used to assess changes in RP candidates stratified by D'Amico classification and Gleason score.
• Exclusion of patients who received neoadjuvant androgen deprivation or radiotherapy prior to RP.

Main Results:

• A significant decrease in low-risk PCa patients undergoing RP (from 17% to 9%) and Gleason score 6 (GS6) PCa patients (from 30% to 14%) was observed.
• These trends remained significant after multivariable adjustment.
• A trend towards a higher proportion of intermediate-risk PCa patients undergoing RP was noted.

Conclusions:

• Inverse stage migration is occurring in contemporary RP cohorts.
• There is a significant reduction in low-risk and GS6 PCa patients undergoing RP.
• Patient selection for radical prostatectomy is becoming more precise, favoring intermediate-risk cases.