Reverse stage shift at a tertiary care center: Escalating risk in men undergoing radical prostatectomy Journal Article

Authors: Silberstein, J. L.; Vickers, A. J.; Power, N. E.; Fine, S. W.; Scardino, P. T.; Eastham, J. A.; Laudone, V. P.
Article Title: Reverse stage shift at a tertiary care center: Escalating risk in men undergoing radical prostatectomy
Abstract: BACKGROUND: The objective of this study was to evaluate changes in clinical and pathologic characteristics of prostate cancer in patients who underwent surgery at a large tertiary care center in the context of increased use of active surveillance (AS) and minimally invasive surgery (MIS). METHODS: The authors retrospectively reviewed 6624 patients with localized prostate cancer who underwent radical prostatectomy from 2000 to 2010 at Memorial Sloan-Kettering Cancer Center. Patients were stratified by surgical approach (open, laparoscopic, or robotic) and by risk category (low, intermediate, or high). Patients with low-risk disease, without intervention, and with a minimum follow-up of 6 months were considered to have elected AS. RESULTS: The number of patients who had AS increased from <20 per year between 2000 and 2004 to ≥100 per year between 2007 and 2009. Over the same decade, the number of patients who underwent MIS (laparoscopic or robotic) increased from zero to 63% of all surgical cases. The percentage of patients in the intermediate-risk and high-risk categories increased over time, whereas the percentage of patients in the low-risk category decreased (odds ratio [OR] per year, 0.91; 95% confidence interval [CI], 0.89-0.92; P <.0005). The proportion of patients who underwent surgery with Gleason 6 tumors decreased over time (OR per year, 0.87; 95% CI, 0.85-0.88; P <.0005), whereas pathologic stage and Gleason score increased (P <.0005). The proportion of low-risk patients decreased across all types of surgery, and the largest decrease was observed for robotic surgery (P <.0005). CONCLUSIONS: A reverse stage shift was observed in patients who underwent radical prostatectomy after 2000 despite the introduction and rapid proliferation of MIS. This shift may have been caused in part by the increased use of AS and an institutional focus on the treatment of higher risk disease. © 2011 American Cancer Society.
Keywords: adult; middle aged; cancer surgery; surgical technique; major clinical study; cancer staging; follow up; neoplasm staging; laparoscopic surgery; treatment indication; prostate specific antigen; surgical approach; retrospective study; risk; prostate cancer; gleason score; prostatic neoplasms; intervention study; prostatectomy; active surveillance; watchful waiting; minimally invasive surgery; cancer epidemiology; robotics; tertiary health care; trend study; robotic; prostatic neoplasm
Journal Title: Cancer
Volume: 117
Issue: 21
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2011-01-01
Start Page: 4855
End Page: 4860
Language: English
DOI: 10.1002/cncr.26132
PROVIDER: scopus
PMCID: PMC3181272
PUBMED: 21484780
Notes: --- - "Export Date: 9 December 2011" - "CODEN: CANCA" - "Source: Scopus"
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MSK Authors
  1. Vincent Laudone
    59 Laudone
  2. Peter T Scardino
    621 Scardino
  3. Nicholas Edgar Power
    17 Power
  4. Andrew J Vickers
    556 Vickers
  5. James Eastham
    426 Eastham
  6. Samson W Fine
    315 Fine