Twenty-year trends in prostate cancer stage and grade migration in a large contemporary german radical prostatectomy cohort

Prostate. 2021 Sep;81(12):849-856. doi: 10.1002/pros.24181. Epub 2021 Jun 10.


Background: A trend towards inverse stage migration in prostate cancer (PCa) was reported. However, previous analyses did not take into account potential differences in sampling strategies (number of biopsy cores), which might have confounded these reports.

Material and methods: Within our single-institutional database we identified PCa patients treated with radical prostatectomy (RP) between 2000 and 2020 (n = 21,646). We calculated the estimated annual percentage change (EAPC) for D'Amico risk groups, biopsy Gleason Grade Group (GGG), PSA and cT stage as well as postoperative RP GGG and pT stage relying on log linear regression methodology. Subsequently, we repeated the analyses after adjustment for number of cores obtained at biopsy.

Results: Absolute rates of D'Amico low risk decreased (-30.1%), while intermediate and high risk increased (+21.2% and +9.0%, respectively). Rates of GGG I decreased (-50.0%), while GGG II-V increased, with the largest increase in GGG II (+22.5%). This trend, albeit less pronounced, was also recorded after adjusted EAPC analyses (p < .05). Specifically, EAPC values for D'Amico low vs intermediate vs high risk were -1.07%, +0.37%, +0.45%, respectively, and EAPC values for GGG ranged between -0.71% (GGG I) and +0.80% (GGG IV). Finally, an increase in ≥cT2 (EAPC: +3.16%) was displayed (all p < .001). These trends were confirmed in EAPC calculations in RP GGG and pT stages (p < .001).

Conclusion: Our findings confirm the trend towards less frequent treatment of low risk PCa and more frequent treatment of high risk PCa, also after adjustment for number of biopsy cores.

Trial registration: NCT04063566 NCT03702439.

Keywords: Gleason Grade Group; biopsy cores; clinical stage; risk group; stage migration.

MeSH terms

  • Aged
  • Cell Movement / physiology*
  • Cohort Studies
  • Databases, Factual / trends
  • Germany / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Grading
  • Prostatectomy / methods
  • Prostatectomy / trends*
  • Prostatic Neoplasms / diagnostic imaging
  • Prostatic Neoplasms / epidemiology*
  • Prostatic Neoplasms / surgery*
  • Time Factors

Associated data

  • ISRCTN/ISRCTN54449243