Mp68-14 Changing Times: Trends in Tumor Upstaging After Radical Prostatectomy. Results From a Contemporary National Cancer Database Study

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II (MP68)1 May 2024MP68-14 CHANGING TIMES: TRENDS IN TUMOR UPSTAGING AFTER RADICAL PROSTATECTOMY. RESULTS FROM A CONTEMPORARY NATIONAL CANCER DATABASE STUDY Pedro F. S. Freitas, Adam D. C. Williams, Ruben Blachman-Braun, Nachiketh Soodana-Prakash, Chad R. Ritch, Sanoj Punnen, Mark L. Gonzalgo, Dipen J. Parekh, and Bruno Nahar Pedro F. S. FreitasPedro F. S. Freitas , Adam D. C. WilliamsAdam D. C. Williams , Ruben Blachman-BraunRuben Blachman-Braun , Nachiketh Soodana-PrakashNachiketh Soodana-Prakash , Chad R. RitchChad R. Ritch , Sanoj PunnenSanoj Punnen , Mark L. GonzalgoMark L. Gonzalgo , Dipen J. ParekhDipen J. Parekh , and Bruno NaharBruno Nahar View All Author Informationhttps://doi.org/10.1097/01.JU.0001008744.60568.e8.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer (PCa) management has significantly changed with improved screening, MRI diagnostic pathway, robotic surgery, and conservative treatments like active surveillance and focal therapy. Higher rates of pathologic T3 stage and positive surgical margins (PSM) are thus expected as radical prostatectomy (RP) has been increasingly performed on men with higher-risk cancer. We assessed clinical (cT) and pathologic tumor (pT) stage trends across NCCN risk groups to detect shifts in PCa upstaging post-RP. METHODS: We queried the National Cancer Database for clinical and postoperative information from all men undergoing upfront RP between 2004 – 2020. Patients were categorized by NCCN risk groups and variables were assessed over 3 time periods: 2004 – 2009, 2010 – 2015, and 2016 – 2020. Trends in cT, Gleason grade (GG), and PSA levels were assessed over time. The primary outcome was tumor upstaging, defined as cT1-T2 stage PCa found to be ≥pT3 after RP. RESULTS: 665,217 patients were included. In the three time periods, percentages of high-risk and intermediate-risk groups changed from 16% to 19% to 27% and from 55% to 50% to 60%, respectively. These shifts corresponded with a drop in low-risk cases (p20 ng/mL rates (Figure 1). Tumor upstaging increased in high-risk (5% to 14%) and intermediate-risk (10% to 20%) patients across the time periods (p<0.001), with no notable change in low-risk cases (p=0.609, Figure 2). CONCLUSIONS: Our study shows that the increase in higher-risk PCa was mainly driven by changes in Gleason grades, with less impact from PSA levels. This rise in tumor upstaging persisted despite greater availability and improved expertise in prostate MRI. These trends should inform surgical decision-making, where more fascia and nerve-sparing approaches might elevate PSM incidence and potentially compromise the oncologic effectiveness of RP. Download PPTDownload PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1114 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Pedro F. S. Freitas More articles by this author Adam D. C. Williams More articles by this author Ruben Blachman-Braun More articles by this author Nachiketh Soodana-Prakash More articles by this author Chad R. Ritch More articles by this author Sanoj Punnen More articles by this author Mark L. Gonzalgo More articles by this author Dipen J. Parekh More articles by this author Bruno Nahar More articles by this author Expand All Advertisement PDF downloadLoading ...