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Inverse stage migration patterns in North American patients undergoing local prostate cancer treatment: a contemporary population-based update in light of the 2012 USPSTF recommendations

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Abstract

Purpose

Recent studies demonstrated ongoing inverse stage migration in prostate cancer (PCa) patients towards more advanced and unfavorable tumors. The USPSTF grade D recommendation may impact this trend in North American patients. We assessed contemporary stage migration and treatment trends in a large North American cohort diagnosed with PCa 2009–2014.

Methods

Time-trend analyses were performed in patients within the Surveillance, Epidemiology, and End Results database, with complete data of clinical tumor stage, biopsy Gleason score, and validated PSA values, resulting in 211,645 assessable patients. Patients were stratified according to their different treatment methods [radical prostatectomy (RP), radiotherapy (RT), and no local treatment (NLT)] and according to clinical and pathological risk stratification (D’Amico and CAPRA-S score).

Results

Over time, proportions of D’Amico low-risk (LR) decreased, with an increase in intermediate-to-high-risk (IR/HR) patients. These trends were more distinct in men ≥ 70 years. NLT proportions increased, most notably in D’Amico LR and/or older patients. Conversely, RP proportions remained stable in younger HR and increased in older HR patients. Similar patterns were demonstrated in the RP-treated subgroup: D’Amico HR, pT3, and/or lymph-node invasion or CAPRA-S HR proportions increased from 23.5 to 30.8, 24.3 to 32.9, and 10.7 to 16.3% (each p ≤ 0.015).

Conclusions

Inverse stage migration with increase of unfavorable PCa continues in most contemporary North American patients. However, a paradigm shift to treat LR patients with less invasive methods (NLT) was demonstrated. Contrary, HR patients increasingly undergo LT. Future studies with long-term follow-up might answer if inverse stage migration vs. treatment trends translate into different PCa metastases/mortality rates vs. proposed NLT benefits, particularly related to USPSTF-recommended reduced PSA screening.

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Abbreviations

AJCC:

American Joint Committee on Cancer

CAPRA-S:

Cancer of the Prostate Risk Assessment-S

EAPC:

Estimated annual percentage change

GS:

Gleason score

HR:

High risk

IR:

Intermediate risk

LR:

Low risk

NCCN:

National Comprehensive Cancer Network

NLT:

No local treatment

PCa:

Prostate cancer

PSA:

Prostate-specific antigen

RP:

Radical prostatectomy

RT:

Radiation therapy

SEER:

Surveillance, epidemiology, and end results

UCSF:

University of California, San Francisco

USPSTF:

United States Preventive Services Task Force

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Acknowledgments

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Sami-Ramzi Leyh-Bannurah and Pierre I. Karakiewicz shared first authorship.

Authors and Affiliations

  1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada

    Sami-Ramzi Leyh-Bannurah, Pierre I. Karakiewicz, Raisa S. Pompe, Felix Preisser, Emanuele Zaffuto & Paolo Dell’Oglio

  2. Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany

    Sami-Ramzi Leyh-Bannurah, Raisa S. Pompe, Felix Preisser, Thomas Steuber, Markus Graefen & Lars Budäus

  3. Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Sami-Ramzi Leyh-Bannurah & Margit Fisch

  4. Department of Urology, University of Montreal Health Center, Montreal, Canada

    Pierre I. Karakiewicz

  5. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Emanuele Zaffuto, Paolo Dell’Oglio & Alberto Briganti

  6. Department of Urology, Elbe Klinikum Stade, Stade, Germany

    Omar Nafez

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  1. Sami-Ramzi Leyh-Bannurah
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Contributions

Conception/design of the study: L-B, PIK, MF, LB, MG, and AB. Data analysis: L-B, PIK, FP, RSP, EZ, LB, and PDO. Data interpretation: L-B, EZ, PIK, AB, LB, TS, ON, and PDO. Manuscript drafting: L-B, FP, EZ, PIK, and MF. Critical revision: RSP, AB, PDO, TS, LB, MG, and MF.

Corresponding author

Correspondence to Sami-Ramzi Leyh-Bannurah.

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All patients provided written informed consent.

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All authors of this research paper have directly participated in the planning, execution, or analysis of the study. All authors of this paper have read and approved the final version submitted. The contents of this manuscript have not been copyrighted or published previously. The contents of this manuscript are not under consideration for publication elsewhere.

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Leyh-Bannurah, SR., Karakiewicz, P.I., Pompe, R.S. et al. Inverse stage migration patterns in North American patients undergoing local prostate cancer treatment: a contemporary population-based update in light of the 2012 USPSTF recommendations. World J Urol 37, 469–479 (2019). https://doi.org/10.1007/s00345-018-2396-2

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