Risk assessment among prostate cancer patients receiving primary androgen deprivation therapy.
OBJECTIVE
Prostate cancer epidemiology has been marked overall by a downward risk migration over time. However, in some populations, both in the United States and abroad, many men are still diagnosed with high-risk and/or advanced disease. Primary androgen deprivation therapy (PADT) is frequently offered to these patients, and disease risk prediction is not well-established in this context. We compared risk features between large disease registries from the United States and Japan, and aimed to build and validate a risk prediction model applicable to PADT patients.


METHODS
Data were analyzed from 13,740 men in the United States community-based Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry and 19,265 men in the Japan Study Group of Prostate Cancer (J-CaP) database, a national Japanese registry of men receiving androgen deprivation therapy. Risk distribution was compared between the two datasets using three well-described multivariable instruments. A novel instrument (Japan Cancer of the Prostate Risk Assessment [J-CAPRA]) was designed and validated to be specifically applicable to PADT patients, and more relevant to high-risk patients than existing instruments.


RESULTS
J-CaP patients are more likely than CaPSURE patients to be diagnosed with high-risk features; 43% of J-CaP versus 5% of CaPSURE patients had locally advanced or metastatic disease that could not be stratified with the standard risk assessment tools. J-CAPRA--scored 0 to 12 based on Gleason score, prostate-specific antigen level, and clinical stage--predicts progression-free survival among PADT patients in J-CaP with a c-index of 0.71, and cancer-specific survival among PADT patients in CaPSURE with a c-index of 0.84.


CONCLUSIONS
The novel J-CAPRA is the first risk instrument developed and validated for patients undergoing PADT. It is applicable to those with both localized and advanced disease, and performs well in diverse populations.
Cooperberg
Matthew R
MR
Department of Urology, University of California, San Francisco, 1600 Divisadero St, A-607, San Francisco, CA 94143-1695, USA. mcooperberg@urology.ucsf.edu
Hinotsu
Shiro
S
Namiki
Mikio
M
Ito
Kazuto
K
Broering
Jeanette
J
Carroll
Peter R
PR
Akaza
Hideyuki
H
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D015331:Cohort Studies; D018572:Disease-Free Survival; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009919:Orchiectomy; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D012042:Registries / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D000726:Androgen Antagonists