Prostate Cancer Coverage from Every Angle

High-Risk Prostate Cancer: Three-Tiered Classification System Under Study

By: Anna Nowogrodzki
Posted: Monday, October 19, 2020

Men with high-risk prostate cancer treated with surgery can be classified into three tiers—favorable high risk, standard high risk, and very high risk—which differ in their 5-year overall survival and rates of adverse factors, according to a recent retrospective study. Vinayak Muralidhar, MD, of Massachusetts General Hospital, Boston, and colleagues published their findings in Urology.

“These findings may help tailor treatment decision-making for men with favorable high-risk or very high–risk disease, potentially allow for more efficient clinical trial design, and help tailor the use of advanced imaging in the preoperative evaluation of patients with unfavorable-risk prostate cancer,” the authors wrote.

The study included 89,450 patients from the National Cancer Database, who had high-risk prostate cancer treated with radical prostatectomy. The authors compared the rates of adverse pathologic factors—positive surgical margins, T4 disease, and pathologic lymph node involvement—across subgroups.

Patients with favorable high-risk disease had similar rates of adverse features (between 7% and 8%) and similar 5-year overall survival (about 95%) as patients with unfavorable intermediate-risk disease. By contrast, patients with standard high-risk or very high–risk disease were significantly more likely to have adverse pathologic factors (15.9% and 26.5%, respectively) as well as worse 5-year overall survival (93% and 88%, respectively).

Should a prospective study validate these findings, the authors suggested, “trials testing adjuvant or neoadjuvant therapies in high-risk disease patients should focus on enrolling standard or very high–risk disease patients as opposed to those with favorable high-risk disease, who have lower event rates.”

Disclosure: The study authors’ disclosure information may be found at

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