Unification of favourable intermediate‐, unfavourable intermediate‐, and very high‐risk stratification criteria for prostate cancer

Zumsteg, Zachary S.; Zeléfsky, Michael J.; Woo, Kaitlin M.; Spratt, Daniel E.; McBride, Sean; Pei, Xin; Sandler, Howard M.; Zhang, Zhigang

doi:10.1111/bju.13903

Cited by 37 publications

(30 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thus, these results are not necessarily applicable to all clinical practice environments or patient populations. However, our findings are consistent with what has been previously described for intermediate and high‐risk prostate cancer in other settings . The follow‐up for VHR patients was also significantly shorter than the follow‐up time for other patients in the SEARCH database.…”

Section: Discussionsupporting

confidence: 91%

“…Our results are remarkably consistent with a recent study of prostate cancer patients undergoing dose‐escalated radiation therapy (RT) with or without androgen deprivation therapy at a high‐volume academic institution . As in this study, VHR patients were found to have dramatically worse outcomes following RT in comparison to SHR patients.…”

Section: Discussionsupporting

confidence: 91%

“…Additionally, the use and timing of salvage therapy, which is known to impact DM and PCSM, was not accounted for in our analysis. Nevertheless, we believe our study has several strengths, such as a relatively uniform treatment paradigm, excluding patients receiving androgen deprivation or adjuvant radiotherapy, a relatively large cohort, and a multi‐institutional setting including numerous urologists, and we think that the results are robust despite their inherent limitations, especially in combination with similar reported results from patients undergoing radiotherapy …”

Section: Discussionmentioning

confidence: 82%

See 2 more Smart Citations

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

et al. 2017

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 82%

See 1 more Smart Citation

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

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…They may now need to adapt their risk stratification based on ISUP grades. Indeed, the current National Comprehensive Cancer Network (NCCN) guidelines on prostate cancer distinguishes between favourable and unfavourable intermediate risk based, among others, on the distinction between ISUP grades 2 and 3 . Similarly, the Cancer of the Prostate Risk Assessment (CAPRA) score for biopsies and prostatectomy specimens distinguishes ISUP grades 2 and 3 .…”

Section: Isup 2014 Grading Of Prostate Cancermentioning

confidence: 99%

“…Indeed, the current National Comprehensive Cancer Network (NCCN) guidelines on prostate cancer distinguishes between favourable and unfavourable intermediate risk based, among others, on the distinction between ISUP grades 2 and 3. 47 Similarly, the Cancer of the Prostate Risk Assessment (CAPRA) score for biopsies and prostatectomy specimens distinguishes ISUP grades 2 and 3. 48 A potential disadvantage of the ISUP 2014 grading system might be the loss of the linkage with the underlying heterogeneity in carcinoma architecture.…”

Section: Isup 2014 Grading Of Prostate Cancermentioning

confidence: 99%

Grading of prostate cancer: a work in progress

2018

View full text Add to dashboard Cite

Grading of prostate cancer has evolved substantially over time, not least because of major changes in diagnostic approach and concomitant shifts from late‐ to early‐stage detection since the adoption of PSA testing from the late 1980s. After the conception of the architecture‐based nine‐tier Gleason grading system more than 50 years ago, several changes were made in order to increase its prognostic impact, to reduce interobserver variation and to improve concordance between prostate needle biopsy and radical prostatectomy grading. This eventually resulted in the current five‐tier grading system, with a much more detailed description of the individual architectural patterns constituting the remaining three Gleason patterns (i.e. grades 3–5). Nevertheless, there is room for improvement. For instance, distinction of common grade 4 subpatterns such as ill‐formed and fused glands from the grade 3 pattern is challenging, blurring the division between low‐risk patients who could be eligible for deferred therapy and those who need curative therapy. The last few years have witnessed the publication of several studies on the prognostic impact of individual architectural subpatterns showing that, in particular, the cribriform pattern exceeded the prognostic impact of other grade 4 subpatterns. This review provides an overview of the changes in prostate cancer grading over time and provides a thorough description of the various Gleason subpatterns, the current evidence of their prognostic impact and areas of contention. Potential practical ways for improvements of the current grading system are also put forward.

show abstract

Development and Validation of a Clinical Prognostic Stage Group System for Nonmetastatic Prostate Cancer Using Disease-Specific Mortality Results From the International Staging Collaboration for Cancer of the Prostate

et al. 2020

Self Cite

View full text Add to dashboard Cite

IMPORTANCEIn 2016, the American Joint Committee on Cancer (AJCC) established criteria to evaluate prediction models for staging. No localized prostate cancer models were endorsed by the Precision Medicine Core committee, and 8th edition staging was based on expert consensus. OBJECTIVE To develop and validate a pretreatment clinical prognostic stage group system for nonmetastatic prostate cancer. DESIGN, SETTING, AND PARTICIPANTSThis multinational cohort study included 7 centers from the United States, Canada, and Europe, the Shared Equal Access Regional Cancer Hospital (SEARCH) Veterans Affairs Medical Centers collaborative (5 centers), and the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry (43 centers) (the STAR-CAP cohort). Patients with cT1-4N0-1M0 prostate adenocarcinoma treated from January 1, 1992, to December 31, 2013 (follow-up completed December 31, 2017. The STAR-CAP cohort was randomly divided into training and validation data sets; statisticians were blinded to the validation data until the model was locked. A Surveillance, Epidemiology, and End Results (SEER) cohort was used as a second validation set. Analysis was performed from January 1, 2018, to November 30, 2019.EXPOSURES Curative intent radical prostatectomy (RP) or radiotherapy with or without androgen deprivation therapy.MAIN OUTCOMES AND MEASURES Prostatecancer-specificmortality(PCSM).Basedonacompetingrisk regression model, a points-based Score staging system was developed. Model discrimination (C index), calibration, and overall performance were assessed in the validation cohorts. RESULTSOf 19 684 patients included in the analysis (median age, 64.0 [interquartile range (IQR), 59.0-70.0] years), 12 421 were treated with RP and 7263 with radiotherapy. Median follow-up was 71.8 (IQR, 34.3-124.3) months; 4078 (20.7%) were followed up for at least 10 years. Age, T category, N category, Gleason grade, pretreatment serum prostate-specific antigen level, and the percentage of positive core biopsy results among biopsies performed were included as variables. In the validation set, predicted 10-year PCSM for the 9 Score groups ranged from 0.3% to 40.0%. The 10-year C index (0.796; 95% CI, 0.760-0.828) exceeded that of the AJCC 8th edition (0.757; 95% CI, 0.719-0.792), which was improved across age, race, and treatment modality and within the SEER validation cohort. The Score system performed similarly to individualized random survival forest and interaction models and outperformed National Comprehensive Cancer Network (NCCN) and Cancer of the Prostate Risk Assessment (CAPRA) risk grouping 3-and 4-tier classification systems (10-year C index for NCCN 3-tier, 0.729; for NCCN 4-tier, 0.746; for Score, 0.794) as well as CAPRA (10-year C index for CAPRA, 0.760; for Score, 0.782).CONCLUSIONS AND RELEVANCE Using a large, diverse international cohort treated with standard curative treatment options, a proposed AJCC-compliant clinical prognostic stage group system for prostate cancer has been developed. This system may allow con...

show abstract

Unification of favourable intermediate‐, unfavourable intermediate‐, and very high‐risk stratification criteria for prostate cancer

Abstract: Modifying the NCCN risk-stratification system to group FIR with low-risk patients and UIR with SHR patients, results in modestly improved prediction of outcomes, potentially allowing better personalisation of therapeutic recommendations.

Cited by 37 publications

References 28 publications

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

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

Grading of prostate cancer: a work in progress

Development and Validation of a Clinical Prognostic Stage Group System for Nonmetastatic Prostate Cancer Using Disease-Specific Mortality Results From the International Staging Collaboration for Cancer of the Prostate

Contact Info

Product

Resources

About