New data indicate that substratification of patients with intermediate-risk prostate cancer—defined by the National Comprehensive Cancer Network (NCCN) as a T2b–T2c tumour, a Gleason score of 7 or serum PSA >20 ng/ml—might improve disease management.

“Published data clearly show heterogeneity in outcomes for patients with intermediate-risk prostate cancer defined by NCCN criteria,” says Sung Hong, who led the study. “As treatment options are contemplated according to NCCN disease risk group, heterogeneity could be a serious problem.”

Hong and co-workers found that a Gleason score of 4 + 3 and the presence of ≥2 NCCN intermediate-risk criteria were independent predictors of the risk of biochemical recurrence (BCR) after radical prostatectomy. Together, these predictors defined an 'unfavourable' intermediate-risk patient subgroup in which 5-year BCR-free survival was 66.5%, compared with 87.5% among patients in a 'favourable' subgroup with Gleason score 3 + 4 and <2 intermediate-risk criteria. Importantly, these 5-year BCR-free survival rates were markedly different than those observed in low-risk and high-risk disease (93.9% and 47.9%, respectively).

These findings confirm the variable outcomes among patients with Gleason 7 prostate cancer, and suggest that further stratification of intermediate-risk disease is required. “Addition of new biomarkers and findings from multiparametric MRI to the existing criteria could also be of interest in this context,” adds Hong.