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

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.

Predicting the probability of pT3 or higher pathological stage at radical prostatectomy: COVID19-specific considerations

“…The optimal therapeutic strategy differs among groups, ranging from active surveillance for very low and low risk patients, to surgery or radiotherapy for the other groups ( 14 ). The rates of pT3-4/pN1 in PCa patients are not negligible and range from 16% (favorable intermediate risk) to 60% (very high risk), depending on risk level ( 15 – 18 ). Due to highly variable rate of pT3-4/pN1 stage, even within risk level subsets, accurate identification of patients at particularly high pT3-4/pN1 risk is challenging.…”

Risk-adapted approach to prostate cancer screening

“…Система стратификации риска развивается: изменены система градации и стадирование в системе TNM 8-го издания [10], обсуждаются даже разделение группы промежуточного риска на когорты благоприятного и неблагоприятного прогноза [11,12] и возможность внедрения биомаркеров (в том числе геномных [13] и протеомных [14]). Прецизионной должна быть и стратегия ранней диагностики и обследования мужчин, так как риск развития заболевания оказывается неодинаковым среди популяции.…”

Impact of germline CHEK2 mutations on biochemical relapse free survival and metastasis free survival after radical treatment for patients with prostate cancer

“…группе [4]. Среди факторов неблагоприятного прогноза присутствуют не только низкодифференцированная гистологическая градация (индекс Глисона ≥8), но и другие патоморфологические характеристикиналичие лимфоваскулярной опухолевой инвазии [5], периневральной инвазии [6], гистологического варианта протоковой карциномы [7].…”