(UroToday.com) The 2025 APCCC Diagnostics annual meeting featured a session on how to diagnose prostate cancer and a presentation by Dr. Andrea Gallina discussing the prostate cancer risk group system most useful today. Dr. Gallina notes that the ideal risk group classification includes the following:
- Pre-treatment available variables (cheap and easy to obtain)
- Clear and measurable outcomes
- Reliable prediction at different time points
- Applicable to different therapeutic options
One of the original prostate cancer risk stratification schemas used is the D’Amico risk stratification, utilizing PSA, Gleason score, and tumor category to assess 5 year risk of treatment failure:
Contemporary risk groups include the EAU risk groups for biochemical recurrence of localized and locally advanced prostate cancer based on systematic biopsy:
Additional contemporary risk group classifications include CAPRA, MSKCC, NCCN, among many others. In 2020, Zelic and colleagues1 provided a head to head comparison assessing different pretreatment risk stratification tools for predicting prostate cancer death. As follows are the prostate cancer risk stratification criteria for different risk grouping systems:
Dr. Gallina notes that this study showed that the MSKCC nomogram, CAPRA score, and CPG risk grouping system performed better in discriminating prostate cancer death, whereas the D’Amico and D’Amico derived systems (NICE, GUROC, EAU, AUA, and NCCN) were less precise:
There are several critical points for assessing the best risk grouping system, including:
- Differences in the outcomes create a lot of confusion regarding the “best” tool
- Several variables need to be updated, after demonstrating their reliability:
- Clinical stage (DRE versus MRI)
- N-stage (conventional imaging versus PSMA PET)
- M-stage (conventional imaging versus PSMA PET)
- Biomarkers (?)
- Genetics (?)
Moreover, risk group classification tools/nomograms should be able to handle missing data, change predictions with changing data, change predictions with changes in the status of the patient, and have greater flexibility (with the possibility of generating predictions for more than one outcome).
Dr. Gallina concluded his presentation by discussing the prostate cancer risk group system most useful today by emphasizing that individualized prediction for patients is needed and that from a patient perspective, “I am a patient, not a statistic”
Presented by: Andrea Gallina, Ospedale Regionale di Lugano, Civico USI, Universita della Svizzera Italiana, Lugano, Ticino, Switzerland
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the Advanced Prostate Cancer Consensus Conference (APCCC) Diagnostics 2025 Annual Meeting, Virtual and Lugano, Switzerland, Thurs, Feb 27 – Fri, Feb 28, 2025.
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