Revisiting current National Comprehensive Cancer Network (NCCN) high-risk prostate cancer stratification: a National Cancer Database analysis

Harshit Garg, Furkan Dursun, Fadi Alsayegh, Hanzhang Wang, Shenghui Wu, Michael A Liss, Dharam Kaushik, Robert S. Svatek, Ahmed M Mansour Elkenany

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: High-risk prostate cancer includes heterogenous populations with variable outcomes. This study aimed to compare the prognostic ability of individual high-risk factors, as defined by National Comprehensive Cancer Network (NCCN) risk stratification, in prostate cancer patients undergoing radical prostatectomy. Methods: We queried the National Cancer Database from 2004 to 2018 for patients with non-metastatic high-risk prostate cancer who underwent radical prostatectomy and stratified them as Group H1: Prostate specific antigen (PSA) > 20 ng/ml alone, Group H2: cT3a stage alone and Group H3: Gleason Grade (GG) group 4/5 as per NCCN guidelines. The histopathological characteristics and rate of adjuvant therapy were compared between different groups. Inverse probability weighting (IPW)-adjusted Kaplan–Meier curves were utilized to compare overall survival (OS) in group H1 and H2 with H3. Results: Overall, 61,491 high-risk prostate cancer patients were identified, and they were classified into Group H1 (n = 14,139), Group H2 (n = 2855) and Group H3 (n = 44,497). Compared to group H1 or H2, pathological GG group > 3 (p < 0.001), pathological stage pT3b or higher (p < 0.001), lymph nodal positive disease (pN1) (p < 0.001) and rate of adjuvant therapy (p < 0.001) were significantly in Group H3. IPW-adjusted Kaplan–Meier curves showed significantly better 5-year OS in group H1 compared to group H3 [95.1% vs 93.3%, p < 0.001] and group H2 compared to group H3 [94.4% vs 92.9%, p < 0.001]. Conclusion: PSA > 20 ng/ml or cT3a stage in isolation have better oncologic and survival outcomes compared to GG > 3 disease and sub-stratification of ‘High-risk’ category might lead to better patient prognostication.

Original languageEnglish (US)
Pages (from-to)244-251
Number of pages8
JournalProstate Cancer and Prostatic Diseases
Issue number2
StatePublished - Jun 2024

ASJC Scopus subject areas

  • Urology
  • Oncology
  • Cancer Research


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