Improving the Stratification of Patients With Intermediate-risk Prostate Cancer |
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| Authors: | Lara Franziska Stolzenbach Luigi Nocera Claudia Collà-Ruvolo Zhe Tian Sophie Knipper Tobias Maurer Derya Tilki Markus Graefen Pierre I. Karakiewicz |
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| Affiliation: | 1. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada;3. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;4. Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy;5. Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Italy;6. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;7. Departments of Urology, Weill Cornell Medical College, New York, NY;8. Department of Urology, University of Texas Southwestern, Dallas, TX;9. Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic;10. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia;11. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan |
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| Abstract: | BackgroundIntermediate-risk prostate cancer (IR PCa) phenotypes may vary from favorable to unfavorable. National Comprehensive Cancer Network (NCCN) criteria help distinguish between those groups. We studied and attempted to improve this stratification.Patients and MethodsA total of 4048 (NCCN favorable: 2015 [49.8%] vs. unfavorable 2033 [50.2%]) patients with IR PCa treated with radical prostatectomy were abstracted from an institutional database (2000-2018). Multivariable logistic regression models predicting upstaging and/or upgrading (Gleason Grade Group [GGG] IV-V and/or ≥ pT3 or pN1) in IR PCa were developed, validated, and directly compared with the NCCN IR PCa stratification.ResultsAll 4048 patients were randomly divided between development (n = 2024; 50.0%) and validation cohorts (n = 2024; 50.0%). The development cohort was used to fit basic (age, prostate-specific antigen, clinical T stage, biopsy GGG, and percentage of positive cores [all P < .001]) and extended models (age, prostate-specific antigen, clinical T stage, biopsy GGG, prostate volume, and percentage of tumor within all biopsy cores [all P < .001]). In the validation cohort, the basic and the extended models were, respectively, 71.4% and 74.7% accurate in predicting upstaging and/or upgrading versus 66.8% for the NCCN IR PCa stratification. Both models outperformed NCCN IR PCa stratification in calibration and decision curve analyses (DCA). Use of NCCN IR PCa stratification would have misclassified 20.1% of patients with ≥ pT3 or pN1 and/or GGG IV to V versus 18.3% and 16.4% who were misclassified using the basic or the extended model, respectively.ConclusionBoth newly developed and validated models better discriminate upstaging and/or upgrading risk than the NCCN IR PCa stratification. |
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| Keywords: | Active surveillance Favorable Nomogram Non-metastatic prostate cancer Unfavorable intermediate-risk prostate cancer |
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