Determining a prostate cancer patient’s risk is essential in identifying which treatment is appropriate for each individual. Now, patients can be offered a more accurate prediction of their risk with a novel stratification method developed by researchers at the University of Cambridge in England.
The study, “Improving Clinical Risk Stratification at Diagnosis in Primary Prostate Cancer: A Prognostic Modeling Study,” published in PLOS Medicine, may help doctors more accurately choose the best treatment option for their patients.
Depending on their risk, patients with non-metastatic prostate cancer may receive treatments that range from surgery to management by regular observation. Currently, the stratification of patients into low, intermediate, or high-risk is performed using the patient’s clinical information at diagnosis, including prostate-specific antigen (PSA) concentration, Gleason pathological grade, and clinical stage.
However, this three-stratum classification system results in significant heterogeneity within groups, which leads to key problems in the management of patients, including overtreatment of indolent cancers or undertreatment of potentially aggressive tumors. And the model had not been properly validated against prostate cancer mortality as an outcome.
Now, the researchers examined data from 10,139 men and developed a new grading system that scores patients from 1-5 based on routinely available clinical measurements, such as PSA levels, disease stage, and tumor grade defined through biopsies.
Patients’ risk was assessed with either the new method or with the three-stratum risk stratification system. Results revealed that the currently used method, endorsed by most national and international guidelines, could not accurately predict mortality in prostate cancer patients at diagnosis.
The five-subgroup stratification system not only performed much better in predicting the risk of cancer death, but it also allowed for a better distinction of patients into subgroups, which may improve clinical decision making.
Although these findings suggest that the new method should be implemented in the stratification of patients with primary non-metastatic prostate cancer, the researchers note that their study was based on registry records rather than a national prospective study, and had a short follow-up (median 6.9 years).
Therefore, they suggest that further studies with additional cohorts and longer follow-up times should be performed to further validate the system.