Changing nationwide trends away from overtreatment among patients undergoing radical prostatectomy over the past 25 years

Valentin H. Meissner, Viviane Glöckler, Matthias Jahnen, Stefan Schiele, Jürgen E. Gschwend, Kathleen Herkommer

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: The objective of the current study was to assess whether and how preoperative risk group distribution and pathological outcomes have changed in men treated with radical prostatectomy (RP) over the past 25 years. Methods: 11,071 patients from a large contemporary registry-based nationwide cohort with RP as primary treatment between 1995 and 2019 were included. Preoperative risk stratification, postoperative outcomes, and 10 years other-cause mortality (OCM) were analyzed. Results: After 2005, the proportion of low-risk prostate cancer (PCa) decreased from 39.6% to 25.5% in 2010 and decreased further to 15.5% in 2015, and 9.4% in 2019 (p < 0.001). The proportion of high-risk cases increased from 13.1% in 2005 to 23.1% in 2010 and 36.7% in 2015, and 40.4% in 2019 (p < 0.001). After 2005, the proportion of cases with favorable localized PCa decreased from 37.3% to 24.9% in 2010 and decreased further to 13.9% in 2015, and 1.6% in 2019 (p < 0.001). The overall 10 years OCM was 7.7%. Conclusion: The current analysis documents a clear shift in utilization of RP toward higher-risk PCa in men with long life expectancy. Patients with low-risk PCa or favorable localized PCa are rarely operated. This suggests a shift in applying surgery only to patients who may really benefit from RP and the long-standing discussion of overtreatment might become outdated.

Original languageEnglish
Pages (from-to)1497-1502
Number of pages6
JournalWorld Journal of Urology
Volume41
Issue number6
DOIs
StatePublished - Jun 2023
Externally publishedYes

Keywords

  • Active surveillance
  • Overtreatment
  • Prostate cancer
  • Radical prostatectomy
  • Risk classification
  • Treatment trends

Fingerprint

Dive into the research topics of 'Changing nationwide trends away from overtreatment among patients undergoing radical prostatectomy over the past 25 years'. Together they form a unique fingerprint.

Cite this