Combined-modality staging for localized adenocarcinoma of the prostate.
The goal of identifying a set of pretreatment risk-stratifying factors for patients with localized prostate cancer is to be able to individualize treatment and optimize patient selection for clinical trials. Low-risk patients are most likely to remain disease-free following local therapy, whereas high-risk patients are not. By identifying a high-risk group in which approximately two-thirds of the patients fail biochemically within 10 years following local therapy, the ability to detect a difference in outcome as a result of additional therapy (if any difference exists) is maximized. Specifically, small improvements in outcome associated with the use of novel therapies can be measured more quickly in the high-risk population because of the intrinsically higher failure and progression rates. Therefore, novel therapies should be studied first in high-risk populations using a prospective randomized trial design (ie, local therapy with or without novel therapy). If efficacy is established in the high-risk cohort, then testing could be considered in the low-risk population. This review will demonstrate the ability to risk stratify more than 90% of all patients with clinically localized prostate cancer into low- or high-risk groups for biochemical progression following local therapy using four readily available pretreatment clinical parameters.
D'Amico
A V
AV
Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02115, USA. adamico@jcrt.harvard.edu
D000230:Adenocarcinoma / Q000097:blood* / Q000473:pathology*; D001706:Biopsy; D006801:Humans; D008297:Male; D009367:Neoplasm Staging / Q000379:methods*; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology*; D016019:Survival Analysis; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen