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Changes in Pre-operative and Pathologic Characteristics in Patients Undergoing Radical Prostatectomy by Era
John B Eifler, Jr., Elizabeth B Humphreys, Alan W Partin, Misop Han
Brady Urological Institute, Baltimore, MD

Introduction:In 2005, the International Society of Urological Pathology (ISUP) modified the Gleason scoring system to reduce interobserver variability. We sought to evaluate the recent trends in stage and grade for patients presenting for radical prostatectomy at a single high-volume center.
Materials & Methods: A total of 18,743 men underwent radical prostatectomy from 1982-2010. We compared the distribution of pathologic stage and grade at presentation according to 5 different eras of prostate cancer management.
Results:A higher proportion of men undergoing RP presented with PSA 0-4 since 2005 than from 1999-2005 (p<0.001). Since 2005, more patients underwent radical prostatectomy for biopsy Gleason 7-10 prostate cancer (23.6% from 1999-2005 vs 36.0% after 2005, p <0.001), in patients being upgraded from Gleason 6 to Gleason 7 at RP (20.3% from 1999-2005 vs 26.7% after 2005, p<0.001). However, patients with pathological Gleason 7-10 disease were more likely to have PSA between 0 and 4 ng/ml (20% vs 14%, p <0.001) and organ-confined disease (54% vs 50%, p = 0.005) in the era after 2005 than from 1999-2005.
Conclusions:
: Since 2005, patients are more likely to present with intermediate to high grade disease. However, these patients are more likely to have a low PSA and organ-confined disease than in previous eras.


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