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Prostate. 2017 Dec;77(16):1592-1600. doi: 10.1002/pros.23436. Epub 2017 Oct 10.

Modified risk stratification grouping using standard clinical and biopsy information for patients undergoing radical prostatectomy: Results from SEARCH.

Author information

1
Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.
2
Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California.
3
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.
4
Section of Urology, Durham VA Medical Center, Durham, North Carolina.
5
Division of Urology, Oregon Health and Sciences University, Portland, Oregon.
6
Urology Section, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
7
Department of Urology, UCLA School of Medicine, Los Angeles, California.
8
Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
9
Department of Urology, University of California San Diego Health System, San Diego, California.
10
Section of Urology, Veterans Affairs Medical Center, Augusta, Georgia.
11
Section of Urology, Medical College of Georgia, Augusta, Georgia.
12
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
13
Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.

Abstract

INTRODUCTION:

Prostate cancer is a heterogeneous disease, and risk stratification systems have been proposed to guide treatment decisions. However, significant heterogeneity remains for those with unfavorable-risk disease.

METHODS:

This study included 3335 patients undergoing radical prostatectomy without adjuvant radiotherapy in the SEARCH database. High-risk patients were dichotomized into standard and very high-risk (VHR) groups based on primary Gleason pattern, percentage of positive biopsy cores (PPBC), number of NCCN high-risk factors, and stage T3b-T4 disease. Similarly, intermediate-risk prostate cancer was separated into favorable and unfavorable groups based on primary Gleason pattern, PPBC, and number of NCCN intermediate-risk factors.

RESULTS:

Median follow-up was 78 months. Patients with VHR prostate cancer had significantly worse PSA relapse-free survival (PSA-RFS, P < 0.001), distant metastasis (DM, P = 0.004), and prostate cancer-specific mortality (PCSM, P = 0.015) in comparison to standard high-risk (SHR) patients in multivariable analyses. By contrast, there was no significant difference in PSA-RFS, DM, or PCSM between SHR and unfavorable intermediate-risk (UIR) patients. Therefore, we propose a novel risk stratification system: Group 1 (low-risk), Group 2 (favorable intermediate-risk), Group 3 (UIR and SHR), and Group 4 (VHR). The c-index of this new grouping was 0.683 for PSA-RFS and 0.800 for metastases, compared to NCCN-risk groups which yield 0.666 for PSA-RFS and 0.764 for metastases.

CONCLUSIONS:

Patients classified as VHR have markedly increased rates of PSA relapse, DM, and PCSM in comparison to SHR patients, whereas UIR and SHR patients have similar prognosis. Novel therapeutic strategies are needed for patients with VHR, likely involving multimodality therapy.

KEYWORDS:

prostate cancer; risk stratification; unfavorable intermediate risk; very high-risk prostate cancer

PMID:
28994485
PMCID:
PMC5685668
DOI:
10.1002/pros.23436
[Indexed for MEDLINE]
Free PMC Article

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