Evaluation of the changing landscape of prostate cancer diagnosis and management from 2005 to 2016.

Background: Approaches to prostate cancer (PCa) diagnosis and treatment have evolved significantly over past decades. There has been an increasing focus on minimizing overdiagnosis and overtreatment of clinically insignificant PCa. The objective of this study was to evaluate the changes in the diagnostic approach and initial treatment strategy that has evolved over time in an Australian urological private practice.

Materials and methods: Men with newly diagnosed PCa were identified from the private practice electronic and paper medical records from 2005 to 2016 and data was consolidated into six groups of 2-year intervals. Diagnostic strategy was analyzed with particular reference to the use of multiparametric magnetic resonance imaging (mpMRI) scan and 68 Ga-prostate specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) scans. National Comprehensive Cancer Network risk group stratification was correlated with initial treatment strategy and compared over time.

Results: Chart review identified 839 men who had a mean age of 65.8 years. In 2011-2012, prebiopsy mpMRI scan was introduced. Its uptake correlated with a decrease in numbers of men diagnosed with low risk cancer (r = -0.80, P  = 0.04) and an increase in numbers of men diagnosed with high-risk cancer (r = 0.90, P  = 0.01). The use of 68 Ga-PSMA PET/CT was associated with decreasing use of CT and bone scans performed. Open radical prostatectomy had a declining trend particularly when robotic surgery (robotic assisted radical prostatectomy (RARP)) was introduced. Pelvic lymph node dissections performed progressively decreased. An increased use of luteinizing hormone receptor hormone (LHRH) antagonists was seen in favor of LHRH agonists. Whilst use of high dose rate brachytherapy declined, there was an increased use of low dose rate brachytherapy.

Conclusion: Prebiopsy mpMRI has been associated with an increased proportion of newly diagnosed men having clinically significant PCa. Over time, 68 Ga-PSMA PET/CT scans, robotic assisted radical prostatectomy (RARP) and LHRH antagonists have increased in use, whilst CT and bone scans, and pelvic lymph node dissections have decreased.