Men diagnosed with prostate cancer can be provided with a more accurate estimate of their risk of death from the disease, and treatment planned accordingly, according to a Research Article published by Vincent J. Gnanapragasam, of the University of Cambridge, Cambridge, UK and colleagues in PLOS Medicine.
Prostate cancer is one of the most common cancers affecting men, and the risk of disease progression and death is very variable when the disease is diagnosed while it is localized to the prostate gland. Providing as accurate an estimate as possible of the individual risk is important in planning appropriate treatment, which could range from surgery to management by regular observation, as well as in providing advice and support to patients.
Based on data from more than 10,000 UK men with prostate cancer, Gnanapragasam and colleagues developed a scheme in which men were grouped into 5 strata with different levels of risk of prostate cancer death, based on straightforward, routinely available, clinical measurements such as prostate specific antigen (PSA) level, disease stage, and tumor grade as judged by biopsy. In two large groups of men with prostate cancer analyzed separately, this scheme performed better in predicting the risk of cancer death compared to the current 3 risk strata system endorsed by most national and international guidelines.
The authors noted that, because their study was limited by reliance on cancer registry records and by relatively short duration of follow-up (median 6.9 years), further validation in independent additional cohorts is needed.
In an accompanying Perspective article, Sigrid V. Carlsson and Michael W. Kattan, respectively of the Memorial Sloan Kettering Cancer Center, New York, USA and Cleveland Clinic, Ohio, USA, discuss the importance of accurate risk estimation in prostate cancer to guide decision making by doctors and their patients.
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Research Article
Funding:
There was no specific funding for this project. The Northern Ireland Cancer Registry is funded by the Public Health Agency for Northern Ireland.
Competing Interests:
The authors have declared that no competing interests exist.
Citation:
Gnanapragasam VJ, Lophatananon A, Wright KA, Muir KR, Gavin A, Greenberg DC (2016) Improving Clinical Risk Stratification at Diagnosis in Primary Prostate Cancer: A Prognostic Modelling Study. PLoS Med 13(8): e1002063. doi:10.1371/journal.pmed.1002063
Author Affiliations:
Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, United Kingdom
Institute of Population Health, University of Manchester, Manchester, United Kingdom
Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
National Cancer Registration Service Eastern Office, Public Health England, Cambridge, United Kingdom
Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002063
Contact:
Vincent J. Gnanapragasam
University Lecturer
University of Cambridge
Academic Urology Group
Cambridge Biomedical Research Campus
Hills Road
Cambridge, CB2 0QQ
UNITED KINGDOM
01223274316
vjg29@cam.ac.uk
Perspective Article
Funding:
SVC's work on this paper was supported in part by a Cancer Center Support Grant from the National Cancer Institute made to Memorial Sloan Kettering Cancer Center (P30-CA008748). SVC is also supported by a post-doctoral grant from AFA Insurance.
Competing Interests:
The authors have declared that no competing interests exist.
Citation:
Carlsson SV, Kattan MW (2016) On Risk Estimation versus Risk Stratification in Early Prostate Cancer. PLoS Med 13(8): e1002100. doi:10.1371/journal.pmed.1002100
Author Affiliations:
Department of Surgery and Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
Department of Urology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1002100
Journal
PLoS Medicine