Stratification of high-risk prostate cancer into prognostic categories: A european multi-institutional study

Steven Joniau, Alberto Briganti, Paolo Gontero, Giorgio Gandaglia, Lorenzo Tosco, Steffen Fieuws, Bertrand Tombal, Giansilvio Marchioro, Jochen Walz, Burkhard Kneitz, Pia Bader, Detlef Frohneberg, Alessandro Tizzani, Markus Graefen, Paul Van Cangh, R. Jeffrey Karnes, Francesco Montorsi, Hein Van Poppel, Martin Spahn

Research output: Contribution to journalArticlepeer-review

126 Scopus citations


Background High-risk prostate cancer (PCa) is an extremely heterogeneous disease. A clear definition of prognostic subgroups is mandatory. Objective To develop a pretreatment prognostic model for PCa-specific survival (PCSS) in high-risk PCa based on combinations of unfavorable risk factors. Design, setting, and participants We conducted a retrospective multicenter cohort study including 1360 consecutive patients with high-risk PCa treated at eight European high-volume centers. Intervention Retropubic radical prostatectomy with pelvic lymphadenectomy. Outcome measurements and statistical analysis Two Cox multivariable regression models were constructed to predict PCSS as a function of dichotomization of clinical stage (<cT3 vs cT3-4), Gleason score (GS) (2-7 vs 8-10), and prostate-specific antigen (PSA ≤ 20 ng/ml vs > 20 ng/ml). The first "extended" model includes all seven possible combinations; the second "simplified" model includes three subgroups: a good prognosis subgroup (one single high-risk factor); an intermediate prognosis subgroup (PSA > 20 ng/ml and stage cT3-4); and a poor prognosis subgroup (GS 8-10 in combination with at least one other high-risk factor). The predictive accuracy of the models was summarized and compared. Survival estimates and clinical and pathologic outcomes were compared between the three subgroups. Results and limitations The simplified model yielded an R of 33% with a 5-yr area under the curve (AUC) of 0.70 with no significant loss of predictive accuracy compared with the extended model (R: 34%; AUC: 0.71). The 5- and 10-yr PCSS rates were 98.7% and 95.4%, 96.5% and 88.3%, 88.8% and 79.7%, for the good, intermediate, and poor prognosis subgroups, respectively (p = 0.0003). Overall survival, clinical progression-free survival, and histopathologic outcomes significantly worsened in a stepwise fashion from the good to the poor prognosis subgroups. Limitations of the study are the retrospective design and the long study period. Conclusions This study presents an intuitive and easy-to-use stratification of high-risk PCa into three prognostic subgroups. The model is useful for counseling and decision making in the pretreatment setting.

Original languageEnglish (US)
Pages (from-to)157-164
Number of pages8
JournalEuropean urology
Issue number1
StatePublished - Jan 1 2015


  • High-risk prostate cancer
  • Locally advanced prostate cancer
  • Risk groups
  • Risk stratification

ASJC Scopus subject areas

  • Urology


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