Trend of Adverse Stage Migration in Patients Treated with Radical Prostatectomy for Localized Prostate Cancer

Background: Two recent European studies showed an increasing proportion of non–organ-confined (NOC; pathologic stages T3–4) prostate cancer (PCa) in radical prostatectomy (RP) specimens. Objective: To determine if the trend for NOC and pT3–4 PCa is also evident among contemporary North American patients. Design, setting, and participants: Within the Surveillance, Epidemiology, and End Results database (2010–2014), we identified 58 558 patients with clinically localized PCa treated with RP. Only patients with clinical stage T1–2 and biopsy Gleason grade group (GGG) 1–3 PCa were included. Outcome measurements and statistical analysis: Annual trend analyses and multivariable logistic regression models focused on the rate of NOC PCa, the rate of primary pathologic Gleason ≥4 PCa, and the rate of either NOC PCa and/or primary pathologic Gleason ≥4 PCa. Adjustment was made for clinical tumor characteristics (prostatic specific antigen [PSA], clinical stage, and biopsy GGG). Results and limitations: The rate of NOC PCa increased during the study period (18.7% vs 24.2%; p = 0.002) and remained significant after adjustment (16.9% vs 22.3%; p = 0.001) Similarly, the rate of pathologic primary Gleason ≥4 PCa increased during the study period (16.8% vs 23.0%, p = 0.001) and remained significant after multivariable adjustment (10.8% vs 14.2%; p = 0.002). Moreover, virtually the same findings were recorded when both endpoints were combined. Our results were confirmed in multivariable logistic regression analyses in which year of diagnosis was modeled as a continuous variable or a categorical variable or when a cubic spline approach was used. Conclusions: Rates of NOC PCa and primary Gleason ≥4 PCa increased over time among contemporary North American patients treated with RP. This finding may be related to better acceptance of active surveillance and watchful waiting by North American patients. Patient summary: In this report, we looked at pathologic outcomes for contemporary North American patients treated with radical prostatectomy. We found an increase in non–organ-confined and more aggressive prostate cancer. Rates of non–organ-confined prostate cancer and primary Gleason ≥4 increased over time in a contemporary cohort of North American patients treated with radical prostatectomy. This finding may be associated with better acceptance of active surveillance and watchful waiting by North American prostate cancer patients.