Risk assessment among prostate cancer patients receiving primary androgen deprivation therapy.

PURPOSE Prostate cancer epidemiology has been marked overall by a downward risk migration over time. However, in some populations, both in the United States and abroad, many men are still diagnosed with high-risk and/or advanced disease. Primary androgen deprivation therapy (PADT) is frequently offered to these patients, and disease risk prediction is not well-established in this context. We compared risk features between large disease registries from the United States and Japan, and aimed to build and validate a risk prediction model applicable to PADT patients. METHODS Data were analyzed from 13,740 men in the United States community-based Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry and 19,265 men in the Japan Study Group of Prostate Cancer (J-CaP) database, a national Japanese registry of men receiving androgen deprivation therapy. Risk distribution was compared between the two datasets using three well-described multivariable instruments. A novel instrument (Japan Cancer of the Prostate Risk Assessment [J-CAPRA]) was designed and validated to be specifically applicable to PADT patients, and more relevant to high-risk patients than existing instruments. RESULTS J-CaP patients are more likely than CaPSURE patients to be diagnosed with high-risk features; 43% of J-CaP versus 5% of CaPSURE patients had locally advanced or metastatic disease that could not be stratified with the standard risk assessment tools. J-CAPRA--scored 0 to 12 based on Gleason score, prostate-specific antigen level, and clinical stage--predicts progression-free survival among PADT patients in J-CaP with a c-index of 0.71, and cancer-specific survival among PADT patients in CaPSURE with a c-index of 0.84. CONCLUSION The novel J-CAPRA is the first risk instrument developed and validated for patients undergoing PADT. It is applicable to those with both localized and advanced disease, and performs well in diverse populations.

[1]  A. D'Amico,et al.  Biochemical recurrence after radical prostatectomy for prevalent versus incident cases of prostate cancer , 2008, Cancer.

[2]  Pierre I Karakiewicz,et al.  An updated catalog of prostate cancer predictive tools , 2008, Cancer.

[3]  N. Kinukawa,et al.  Validation of Partin tables and development of a preoperative nomogram for Japanese patients with clinically localized prostate cancer using 2005 International Society of Urological Pathology consensus on Gleason grading: data from the Clinicopathological Research Group for Localized Prostate Cancer , 2008, The Journal of urology.

[4]  A. Partin,et al.  External validation of University of California, San Francisco, Cancer of the Prostate Risk Assessment score. , 2008, Urology.

[5]  Dirk F Moore,et al.  Survival following primary androgen deprivation therapy among men with localized prostate cancer. , 2008, JAMA.

[6]  E. Klein,et al.  Androgen deprivation falls as orchiectomy rates rise after changes in reimbursement in the U.S. Medicare population , 2008, Cancer.

[7]  H. Akaza.  Current status and prospects of androgen depletion therapy for prostate cancer. , 2008, Best practice & research. Clinical endocrinology & metabolism.

[8]  T. Wilt,et al.  Systematic Review: Comparative Effectiveness and Harms of Treatments for Clinically Localized Prostate Cancer , 2008, Annals of Internal Medicine.

[9]  A. Jemal,et al.  Cancer Statistics, 2008 , 2008, CA: a cancer journal for clinicians.

[10]  I. Tannock,et al.  A Contemporary Prognostic Nomogram for Men with Hormone-Refractory Metastatic Prostate Cancer: A TAX327 Study Analysis , 2007, Clinical Cancer Research.

[11]  A. D'Amico,et al.  Androgen deprivation therapy for localized prostate cancer and the risk of cardiovascular mortality. , 2007, Journal of the National Cancer Institute.

[12]  H. Akaza,et al.  Current status of endocrine therapy for prostate cancer in Japan analysis of primary androgen deprivation therapy on the basis of data collected by J-CaP. , 2007, Japanese journal of clinical oncology.

[13]  A. D'Amico,et al.  Guideline for the management of clinically localized prostate cancer: 2007 update. , 2007, The Journal of urology.

[14]  N. Keating,et al.  Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[15]  Y. Homma,et al.  Efficacy of primary hormone therapy for localized or locally advanced prostate cancer: results of a 10‐year follow‐up , 2006, BJU international.

[16]  M. Kattan,et al.  Preoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. , 2006, Journal of the National Cancer Institute.

[17]  Terukazu Nakamura,et al.  Clinical characteristics of prostate cancer in Japanese men in the eras before and after serum prostate‐specific antigen testing , 2005, International journal of urology : official journal of the Japanese Urological Association.

[18]  M. Cooperberg,et al.  The University of California, San Francisco Cancer of the Prostate Risk Assessment score: a straightforward and reliable preoperative predictor of disease recurrence after radical prostatectomy. , 2005, The Journal of urology.

[19]  James A Hanley,et al.  20-year outcomes following conservative management of clinically localized prostate cancer. , 2005, JAMA.

[20]  J. Goodwin,et al.  Increasing use of gonadotropin‐releasing hormone agonists for the treatment of localized prostate carcinoma , 2005, Cancer.

[21]  C. Pashos,et al.  Natural history of bone complications in men with prostate carcinoma initiating androgen deprivation therapy , 2004, Cancer.

[22]  H. Akaza,et al.  Characteristics of patients with prostate cancer who have initially been treated by hormone therapy in Japan: J-CaP surveillance. , 2004, Japanese journal of clinical oncology.

[23]  M. Cooperberg,et al.  The contemporary management of prostate cancer in the United States: lessons from the cancer of the prostate strategic urologic research endeavor (CapSURE), a national disease registry. , 2004, The Journal of urology.

[24]  M. Cooperberg,et al.  Time trends in clinical risk stratification for prostate cancer: implications for outcomes (data from CaPSURE). , 2003, The Journal of urology.

[25]  M. Cooperberg,et al.  National practice patterns and time trends in androgen ablation for localized prostate cancer. , 2003, Journal of the National Cancer Institute.

[26]  P. Kantoff,et al.  Prognostic model for predicting survival in men with hormone-refractory metastatic prostate cancer. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[27]  S B Malkowicz,et al.  Biochemical Outcome After Radical Prostatectomy , External Beam Radiation Therapy , or Interstitial Radiation Therapy for Clinically Localized Prostate Cancer , 2000 .

[28]  A. Renshaw,et al.  Biochemical Outcome after radical prostatectomy, external beam Radiation Therapy, or interstitial Radiation therapy for clinically localized prostate cancer , 1998 .

[29]  M. Kattan,et al.  A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer. , 1998, Journal of the National Cancer Institute.

[30]  J. Ferlay,et al.  Cancer Incidence in Five Continents , 1970, Union Internationale Contre Le Cancer / International Union against Cancer.

[31]  F. Harrell,et al.  Prognostic/Clinical Prediction Models: Multivariable Prognostic Models: Issues in Developing Models, Evaluating Assumptions and Adequacy, and Measuring and Reducing Errors , 2005 .

[32]  M. Garnick.  Current status of endocrine therapy for prostate cancer. , 1987, Oncology.