Key result
Over 18 years, the proportion of low-risk patients undergoing radical prostatectomy declined from 4.5% to 0.6%, while high-risk cases increased from 9.5% to 21.7% (P<0.001).
Why the study?
Active surveillance guidelines and the 2014 ISUP Gleason reclassification have transformed radical prostatectomy practice, prompting an investigation into temporal shifts in patient clinical and pathological characteristics.
How have the clinical and pathological characteristics of patients undergoing radical prostatectomy changed over an 18-year period?
Observational (n=8,358)
Yes
How have the clinical and pathological characteristics of patients undergoing radical prostatectomy changed over an 18-year period?
Absolute Event Rate: 0.6% vs 4.5%
p-value: p=<0.001
There has been a profound shift toward higher-risk and pathologically advanced disease in patients undergoing radical prostatectomy over the past 18 years, likely reflecting successful implementation of active surveillance for low-risk disease.
RP candidates now show markedly higher-risk profiles with advanced pathology; supports successful AS implementation but leaves outcome effects open for prospective study.
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.
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Neuzillet et al. (2026) conducted an observational in Prostate cancer (n=8,358). Later time period (2019-2025) vs. Earlier time period (2007-2012) was evaluated on Proportion of low-risk patients (p=<0.001). Over 18 years, the proportion of low-risk patients undergoing radical prostatectomy declined from 4.5% to 0.6%, while high-risk cases increased from 9.5% to 21.7% (P<0.001).
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