What defines intermediate-risk prostate cancer? Variability in published prognostic models

Area of Science:

• Oncology
• Urology
• Radiotherapy

Background:

• Accurate risk stratification is crucial for optimizing treatment strategies in prostate cancer.
• Existing prognostic models for intermediate-risk prostate cancer often lack precision.
• External beam radiotherapy is a common treatment modality for localized prostate cancer.

Purpose of the Study:

• To evaluate the effectiveness of various prognostic models in defining intermediate-risk prostate cancer.
• To compare the performance of published models against an institutional empiric model.

Main Methods:

• Analysis of 256 men with prostate adenocarcinoma treated with radiotherapy alone.
• Biochemical failure-free survival (bFFS) assessed using univariate, multivariate, and recursive partitioning analyses.
• Comparison of institutional risk classification with published prognostic models.

Main Results:

• Overall 5-year bFFS was 46.8%. Institutional criteria yielded 5-year bFFS of 77.8% (low), 51.1% (intermediate), and 33.8% (high risk).
• Significant variability observed in 5-year bFFS for intermediate-risk groups across models (38.1%–51.1%).
• Recursive partitioning analysis identified risk categories based on PSA and Gleason score.

Conclusions:

• Published prognostic models demonstrate considerable variation in performance when applied to local data.
• PSA and biopsy Gleason score remain key prognostic factors for prostate cancer.
• Further research is needed to enhance prognostic model performance, especially for intermediate-risk disease.