Various risk classification systems (RCSs) are used globally to stratify newly diagnosed patients with prostate cancer (PCa) into prognostic groups.
To compare the predictive value of different prognostic subgroups (low-, intermediate-, and high-risk disease) within the RCSs for detecting metastatic disease on prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) for primary staging, and to assess whether further subdivision of subgroups would be beneficial.
Patients with newly diagnosed PCa, in whom PSMA-PET/CT was performed between 2017 and 2022, were studied retrospectively. Patients were stratified into risk groups based on four RCSs: European Association of Urology, National Comprehensive Cancer Network (NCCN), Cambridge Prognostic Group (CPG), and Cancer of the Prostate Risk Assessment.
The prevalence of metastatic disease on PSMA-PET/CT was compared among the subgroups within the four RCSs.
In total, 2630 men with newly diagnosed PCa were studied. Any metastatic disease was observed in 35% (931/2630) of patients. Among patients classified as having intermediate- and high-risk disease, the prevalence of metastases ranged from approximately 12% to 46%. Two RCSs further subdivided these groups. According to the NCCN, metastatic disease was observed in 5.8%, 13%, 22%, and 62% for favorable intermediate-, unfavorable intermediate-, high-, and very-high-risk PCa, respectively. Regarding the CPG, these values were 6.9%, 13%, 21%, and 60% for the corresponding risk groups.
This study underlines the importance of nuanced risk stratification, recommending the further subdivision of intermediate- and high-risk disease given the notable variation in the prevalence of metastatic disease. PSMA-PET/CT for primary staging should be reserved for patients with unfavorable intermediate- or higher-risk disease.
The use of various risk classification systems in patients with prostate cancer helps identify those at a higher risk of having metastatic disease on prostate-specific membrane antigen positron emission tomography/computed tomography for primary staging.
European urology oncology. 2024 Apr 30 [Epub ahead of print]
Wietske I Luining, Liselotte M S Boevé, Marinus J Hagens, Dennie Meijer, Tessa de Weijer, Rosemarijn H Ettema, Remco J J Knol, Ton A Roeleveld, Sandra Srbljin, Saskia Weltings, Jose C C Koppes, Reindert J A van Moorselaar, Pim J van Leeuwen, Matthijs C F Cysouw, Daniela E Oprea-Lager, André N Vis
Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands. Electronic address: ., Department of Urology, OLVG, Amsterdam, The Netherlands., Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands; Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands., Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands., Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands., Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands., Department of Nuclear Medicine, Northwest Clinics, Alkmaar, The Netherlands., Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands; Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands; Department Urology, Northwest Clinics, Alkmaar, The Netherlands., Department of Nuclear Medicine, Zaans Medical Center, Zaandam, The Netherlands., Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands; Department of Urology, Zaans Medical Center, Zaandam, The Netherlands., Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands., Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands; Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.