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The prostate cancer risk stratification (ProCaRS) project: recursive partitioning risk stratification analysis.
George Rodrigues1, Himu Lukka, Padraig Warde
1Department of Radiation Oncology, London Health Sciences Centre, Canada.
Summary
A new prostate cancer risk stratification system refines the existing GUROC model into six groups, improving prediction accuracy for better treatment decisions. This enhanced prostate cancer risk stratification offers more precise patient management.
Area of Science:
- Urology
- Oncology
- Medical Statistics
Background:
- The Genitourinary Radiation Oncologists of Canada (GUROC) developed a three-group risk stratification (RS) system in 2001 to aid prostate cancer treatment decisions.
- The ProCaRS database, comprising 7974 patients from four Canadian institutions, was used for this study.
Purpose of the Study:
- To statistically model the predictive accuracy and clinical utility of a proposed new multi-group RS schema for prostate cancer.
- To enhance decision-making in prostate cancer management through improved risk stratification.
Main Methods:
- Recursive partitioning analysis (RPA) was employed to explore sub-stratification within the existing three-group GUROC scheme.
- 10-fold cross-validated C-indices and the Net Reclassification Index were used to compare the predictive accuracy of existing and proposed RS systems.
Main Results:
- Recursive partitioning analysis suggests the GUROC system can be expanded to six statistically unique groups based on biochemical failure-free survival (BFFS).
- The proposed system refines GUROC low-risk into favorable-low and low-risk groups (PSA ⩽6 vs. >6), and intermediate-risk into low-intermediate and high-intermediate groups.
- New criteria define GUROC high-intermediate and extreme-risk groups based on PSA levels, tumor characteristics, and positive core percentages, showing improved predictive accuracy (C-index 0.67, AUC 0.70).
Conclusions:
- Proposed risk stratification subcategories have been identified using RPA on the ProCaRS database.
- The refined multi-group RS schema offers potential for more precise prostate cancer patient management.
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