Year: 2016
Type: article
Abstract: Clinically localized prostate cancer (PC) is a heterogeneous disease with highly variable clinical outcome.When counseling a patient with PC, the clinician ought to provide outcome probabilities as accurately as possible, given the patient and data at hand.Here is where the clinical question becomes a statistical one: what is the long-term prognosis and marginal benefit of treatment A versus treatment B versus no treatment-and in relation to death from other causes?Although randomized trials are under way (e.g., UK ProtecT trial), we do not have data on long-term outcomes comparing radical prostatectomy (RP), radiotherapy (RT), and active surveillance (AS) to provide patients with these numbers.To help clinicians communicate prognostic information and guide appropriate management for the patient, a wide array of risk assessment tools combining clinical and pathologic variables are available [1].Risk categories typically combine stage, grade, and prostate-specific antigen (PSA) concentration into categorizations such as "low," "intermediate," or "high" risk.One of the most commonly used is the D'Amico (1998) risk classification system [2], but limitations include significant heterogeneity, i.e., a wide range in risk of biochemical recurrence (BCR) within each risk group stratum-compared with predicting risk using a mathematical formula-and considerable overlap in risk between the intermediate-and high-risk groups [3].A modified risk stratification scheme adopted by the National Comprehensive Cancer Network (NCCN) incorporates very low-and very high-risk groups, number of prostate biopsy cores positive, percent cancer core involvement, and PSA density, but is still limited by heterogeneity in recurrence within the risk strata [4].Recently, novel tissue-based molecular biomarkers have been developed to help sub-stratify risk based on tumor biology [5].Other means of classifying risk include probability tables, such as the Partin tables [6], which combine variables (stage, grade, PSA) into simple-to-use look-up tables, and risk scores, such as the University of California, San Francisco (UCSF)-Cancer of the Prostate Risk Assessment (CAPRA) score [7], which calculates risk through a summation of points for each variable in a total score of 0-10.However, risk strata are often collapsed; for example, the Gleason score (GS) is often re-categorized into a three-tiered grouping (6, 7, and 8-10).In addition, because of the range of the scale (from 6 to 10), some patients misinterpret the lowest score (GS 6) as a "middle" score.Communication of risk then becomes an inaccurate reflection of prognosis and could make some patients with low-risk disease opt for primary treatment over initial expectant management.Also, GS 7 is sometimes used as a single score, when 3+4 = 7 or 4+3 = 7 have been shown to be prognostically different; the first number indicates the predominant, or most
Source: PLoS Medicine
Authors: Sigrid V. Carlsson, Michael W. Kattan
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $6,460
OpenAlex ID: W2480579182