Mp09-11 Trends in Surgical Management of High-risk Prostate Cancer: Evidence of an Evolving Treatment Paradigm
Year: 2016
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: Recent single-institutional studies reported a stage migration towards less aggressive disease at radical prostatectomy (RP) over the last years, even in the context of high risk patients (HRPCa).We verified these trends in a large multi-institutional database (EMPaCT) METHODS: We evaluated data of 10,136 patients treated with RP and ePLND at 14 tertiary care centers between 1987 and 2014 for HRPCa.Patients were stratified according to year of surgery (YOS) quintiles (all percentages represent a comparison between the first and last quintile).We estimated biochemical recurrence (BCR) and cancer specific survival (CSS), using the Kaplan-Meier method.We evaluated changes in clinical and pathological features over time.Finally, we evaluated the relationship between YOS and oncological outcomes using Cox regression analyses.Covariates were age at surgery, YOS, pre-operative PSA, pathological T stage, surgical margins status (SM), pathological GS, and lymph node invasion (LNI) RESULTS: Mean follow-up time was 180 months (median 126).The 5, 10 and 15-year overall BCR and CSS rates were 61.0, 47.5, 41.2% and 95.8, 90.5 and 84.4%, respectively.From 1987 to 2014, a significant change in clinical stage (cT1 rate:10.4% vs. 40.3%),PSA at surgery (PSA > 20 ng/mL: 8.1 vs. 27.7%)and biopsy GS (GS 8-10: 15.3 vs. 44.0%)was observed (all p<0.001).A significant decrease in the rate of positive SM was observed (56.0 vs. 50.0%)while a significant increase in the number of lymph nodes removed was identified through time (more than 15 nodes removed: 35.7 vs. 42.2%;all p<0.001).There was an increase in pathological GS 8-10, LNI and pT3b/pT4 patients (GS 8-10: 12.5 vs. 47.4%;LNI: 24.1 vs. 46.5 %; pT3b/pT4 36.5 vs. 46.2%;all p<0.001).A significant increase in both adjuvant radiotherapy (RT) and adjuvant androgen deprivation therapy (ADT) use was observed (RT: 15.5 vs. 48.8%;ADT 37.5 vs 50.0%; all p<0.001).Year of surgery was significantly associated with BCR (HR per 5-year interval: 0.70, P¼ 0.02), however no correlation was observed when CSS was assessed (HR per 5-year interval 0.87, 95% CI 0.55-1.41;P ¼ 0.6) CONCLUSIONS: Our results demonstrate an increased treatment of more extensive HRPCa over the last two decades.Despite this, better BCR rates and stable cancer specific survival rates were reported, suggesting a possible refinement of surgical approach and more accurate use of multi-modal approach which was able to improve cancer control outcomes over time
Source: The Journal of Urology
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2329249251