科研之友
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摘要
Prostate cancer management changed in recent times given the recommendation against prostate specific antigen screening, adherence to active surveillance, and "cytoreductive" surgery. We hypothesized that radical prostatectomy (RP) findings changed as well. All consecutive RPs (n = 1348) and first time prostate needle biopsies (n = 1719) in a period of 9 years were reviewed. The cohort was separated into 3 groups: (1) from May 2006 to April 2009, (2) from May 2009 to April 2012, and (3) from May 2012 to April 2015. The number of RPs decreased 15% from 551 in group 1 to 476 in group 2 and decreased a further 35% to 311 in group 3. Pure Gleason 6 (grade group 1) decreased from 46% in group 1 to 24% in group 2 (P < .001) to 12% in group 3 (P < .001). Gleason score 4 + 3 = 7 (grade group 3) increased from 9.8% in group 1 to 13.4% in group 2 (P = .07) to 20.6% in group 3 (P = .01). Gleason score 8, 9, or 10 (grade groups 4 and 5) increased from 0.9% in group 1 to 8.4% in group 2 (P < .001) to 13.2% in group 3 (P =.04). Pathologic stage pT3 or above increased from 15.5% in group 1 to 29.2% in group 2 (P < .01) to 38.3% in group 3 (P = .01). In needle biopsies, there was no difference in number of cancer diagnoses, number of positive cores, or distribution of grades among 3 groups. More patients with low-risk disease are opting for active surveillance, and patients with high-risk disease are offered cytoreductive surgery. Lack of similar changes in needle biopsies suggests that a decrease in screening is not playing a role in the changes seen at RPs.
- 出版日期2017-1
