title: Defining high risk prostate cancer--where do we set the bar? A translational science approach to risk stratification.
abstract: OBJECTIVE
  Risk stratification is commonly used in patients with prostate cancer but this effort has had no demonstrable effect on patient decision making for initial therapy. We propose new risk strata for clinically localized prostate cancer.
  
  
  METHODS
  We examined current stratification methods for prostate cancer and their impact on prostate cancer therapy.
  
  
  RESULTS
  Three risk strata for patients with clinically localized prostate cancer are proposed. Stratum 1 includes patients in whom active surveillance is associated with a low risk of disease progression. Stratum 2 includes patients in whom monotherapy, including external beam, interstitial radiotherapy or radical prostatectomy, is generally successful. Stratum 3 includes patients at high risk for recurrence with monotherapy in whom multimodal therapy may be superior.
  
  
  CONCLUSIONS
  Risk stratification systems for prostate cancer should harmonize the needs of researchers to develop comparable groupings of patients, of patients who seek guidance on optimal therapy and of clinical trialists who seek to advance therapy for this disease. Our new stratification system provides such a structure.
authors.affiliation: Department of Urology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. thompsoni@uthscsa.edu
authors.forename: Ian M
authors.initials: IM
authors.lastname: Thompson
mesh_terms: D003657:Decision Making; D018450:Disease Progression; D006801:Humans; D008297:Male; D011379:Prognosis; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000628:therapy*; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors