Login to Access Video or Poster Abstract: MP64-13
Sources of Funding: none

Introduction

There has been increasing emphasis on active surveillance to limit overtreatment of prostate cancer (PC). However, the actual effect that such emphasis has on the selection of patients for radical prostatectomy (RP) has not been well studied. In this study, we investigated the trends in PC pathology at yearly intervals over the past decade to verify any changes in the RP population.

Methods

We retrospectively reviewed information from 1034 patients who underwent open RP between October 2004 and August 2015 by a single surgeon at a high-volume tertiary care center. Information was cataloged into one-year intervals. Chi-squared, Fisher's Exact test, ANOVA, and Kruskal-Wallis test were used for data analysis.

Results

There was significant in-group differences among the one-year intervals regarding pathological Gleason score (p<0.01), pathological staging (p<0.04), extracapsular extension (p <0.001), and positive margins (p=0.0001), with trends in increasing percentages of prostate glands with adverse pathological features over time. There was significant in-group differences in Gleason upgrading (p<0.01), with decreasing pathology upgrading over time. There was significant in-group differences in pre-RP D'Amico risk stratification over time (p<0.01). The percent of patients with pre-RP low-risk D'Amico pathology decreased from 42.9% in 2004 to 24.3% in 2009, increased to 50.9% between 2009 and 2011, then decreased again to 27.8% from 2011 to 2015. There were no significant in-group differences in age, race, or seminal vesicle invasion.

Conclusions

Over the last 10 years, we have increasingly targeted RP to patients with adverse pathology who have greater need for treatment while also reducing Gleason upgrading at RP. Our results indicate decreasing overtreatment and validate the effect that active surveillance emphasis has on changing the population undergoing RP.

Funding

none