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Updated: Jun 28, 2026
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Shifting risk profile in radical prostatectomy over 18 years: A bicentric French study of 8,358 patients
Yann Neuzillet1, Joao Paulo Barbosa De Oliveira2, François Rozet2
1Department of Urology, University of Paris-Saclay - UVSQ, Hôpital Foch, Suresnes, France.
Introduction:
Radical prostatectomy (RP) practice has been transformed by active surveillance (AS) guidelines for low-risk prostate cancer and the 2014 ISUP Gleason reclassification. The aim of this study was to describe the temporal evolution of clinical and pathological characteristics of patients undergoing RP at two high-volume French centers over 18 years.
Material:
We retrospectively analyzed 8,358 consecutive RPs performed between January 2007 and December 2025 at Hôpital Foch and Institut Montsouris (Paris). Patients were stratified by D'Amico risk classification across three periods (2007-2012, 2013-2018, 2019-2025).
Results:
Low-risk patients declined from 4.5% to 0.6% (P<0.001); high-risk patients increased from 9.5% to 21.7% (P<0.001). Biopsy Gleason score≤6 fell from 48.0% to 4.2% (P<0.001). Pathological stage≥pT3 rose from 30.5% to 47.3% (P<0.001) and lymph node involvement (pN1) from 1.0% to 5.4% (P<0.001). Median age increased from 62.6 to 66.2 years (P<0.001). These shifts accelerated after 2012-2014, coinciding with major AFU guideline revisions and the ISUP reclassification.
Conclusion:
This large bicentric series demonstrates a profound and sustained shift in the risk profile of patients undergoing RP over 18 years, with near-disappearance of low-risk cases and growing proportions of high-risk and pathologically advanced disease, which may reflect successful guideline-concordant AS implementation.
Level Of Evidence:
Low.
