Pre-treatment risk stratification of prostate cancer patients:A critical review
The use of accepted prostate cancer risk stratification
groups based on prostate-specific antigen, T stage and Gleason
score assists in therapeutic treatment decision-making, clinical trial
design and outcome reporting. The utility of integrating novel prognostic
factors into an updated risk stratification schema is an area
of current debate. The purpose of this work is to critically review
the available literature on novel pre-treatment prognostic factors
and alternative prostate cancer risk stratification schema to assess
the feasibility and need for changes to existing risk stratification
A systematic literature search was conducted to identify
original research publications and review articles on prognostic factors
and risk stratification in prostate cancer. Search terms included
risk stratification, risk assessment, prostate cancer or neoplasms,
and prognostic factors. Abstracted information was assessed to
draw conclusions regarding the potential utility of changes to existing
risk stratification schema.
The critical review identified three specific clinically relevant
potential changes to the most commonly used three-group
risk stratification system: (1) the creation of a very-low risk category;
(2) the splitting of intermediate-risk into a low- and highintermediate
risk groups; and (3) the clarification of the interface
between intermediate- and high-risk disease. Novel pathological
factors regarding high-grade cancer, subtypes of Gleason score
7 and percentage biopsy cores positive were also identified as
potentially important risk-stratification factors.
Multiple studies of prognostic factors have been performed
to create currently utilized prostate cancer risk stratification
systems. We propose potential changes to existing systems.
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