Very High-Risk Prostate Cancer Criteria Validated as a Risk Stratum

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Men with very high-risk (VHR) PCa are more likely to have adverse pathologic features and outcomes after radical prostatectomy than those with high-risk but not VHR PCa.
Men with very high-risk (VHR) PCa are more likely to have adverse pathologic features and outcomes after radical prostatectomy than those with high-risk but not VHR PCa.

Among men undergoing radical prostatectomy for high-risk prostate cancer (PCa), those with very high-risk (VHR) PCa were significantly more likely to have adverse pathologic features and outcomes, according to investigators.

In a validation study that included 1981 men who underwent RP for high-risk PCa at 3 tertiary care centers from 2005 to 2015, the proportion of patients found to have positive surgical margins was significantly higher among men with VHR cancer compared with those who had high-risk but not VHR cancer (37% vs 25%). The VHR group also had a higher proportion of men with positive lymph nodes (37% vs 15%). Men with VHR cancer had a significant 2.8-fold, 6.8-fold, and 2.4-fold increased risk of metastasis, cancer-specific mortality, and overall mortality, respectively, compared with men who had high-risk but not VHR cancer, a team led by Brian F. Chapin, MD, of the University of Texas MD Anderson Cancer Center in Houston, reported in Cancer.

“Here we have validated criteria for VHR PCa as a risk stratum that identifies men with worse pathologic features and oncologic outcomes after surgery for localized PCa,” Dr Chapin's team wrote. “These criteria may be useful for counseling individual patients regarding the treatment and prognosis for high-risk disease and the risk of needing subsequent post-operative therapies.”

Dr Chapin and his colleagues defined high-risk PCa as clinical stage T3 to T4, a PSA level greater than 20 ng/mL, or a biopsy Gleason sum of 8 to 10. They defined VHR PCa as the presence of multiple high-risk features, more than 4 biopsy cores with a Gleason sum of 8 to 10, or primary Gleason grade pattern 5.

Of the 1981 patients, 602 (30.4%) had VHR PCa. The VHR group had a significantly higher median PSA value compared with the other patients (9.50 vs 6.79 ng/mL) and a higher proportion of men with biopsy Gleason sum 9 (54.2% vs 21.5%) and 10 (6.3% vs 0%).

Reference

Sundi D, Tosoian JJ, Nyame YA, et al. Outcomes of very high-risk prostate cancer after radical prostatectomy: Validation study from 3 centers. Cancer. 2018; published online ahead of print.

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