Defining High Risk Prostate Cancer-Where do we Set the Bar? A Translational Science Approach to Risk Stratification

Purpose: 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. Materials and 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.