Reverse Stage Shift at a Tertiary Care Center: Escalating Risk in Men Undergoing Radical Prostatectomy

The objective of this study was to evaluate changes in clinical and pathologic characteristics of prostate cancer in patients who underwent surgery at a large tertiary care center in the context of increased use of active surveillance (AS) and minimally invasive surgery (MIS). The authors retrospectively reviewed 6624 patients with localized prostate cancer who underwent radical prostatectomy from 2000 to 2010 at Memorial Sloan-Kettering Cancer Center. Patients were stratified by surgical approach (open, laparoscopic, or robotic) and by risk category (low, intermediate, or high). Patients with low-risk disease, without intervention, and with a minimum follow-up of 6 months were considered to have elected AS. The number of patients who had AS increased from