%0 Journal Article
%T A Comparison of Globally Applied Prognostic Risk Groups and the Prevalence of Metastatic Disease on Prostate-specific Membrane Antigen Positron Emission Tomography in Patients with Newly Diagnosed Prostate Cancer.
%A Luining WI
%A Boevé LMS
%A Hagens MJ
%A Meijer D
%A de Weijer T
%A Ettema RH
%A Knol RJJ
%A Roeleveld TA
%A Srbljin S
%A Weltings S
%A Koppes JCC
%A van Moorselaar RJA
%A van Leeuwen PJ
%A Cysouw MCF
%A Oprea-Lager DE
%A Vis AN
%J Eur Urol Oncol
%V 0
%N 0
%D 2024 Apr 30
%M 38693019
%F 8.208
%R 10.1016/j.euo.2024.04.005
%X <B>BACKGROUND: </B>Various risk classification systems (RCSs) are used globally to stratify newly diagnosed patients with prostate cancer (PCa) into prognostic groups.<BR><B>OBJECTIVE: </B>To compare the predictive value of different prognostic subgroups (low-, intermediate-, and high-risk disease) within the RCSs for detecting metastatic disease on prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) for primary staging, and to assess whether further subdivision of subgroups would be beneficial.<BR><B>METHODS: </B>Patients with newly diagnosed PCa, in whom PSMA-PET/CT was performed between 2017 and 2022, were studied retrospectively. Patients were stratified into risk groups based on four RCSs: European Association of Urology, National Comprehensive Cancer Network (NCCN), Cambridge Prognostic Group (CPG), and Cancer of the Prostate Risk Assessment.<BR><B>METHODS: </B>The prevalence of metastatic disease on PSMA-PET/CT was compared among the subgroups within the four RCSs.<BR><B>CONCLUSIONS: </B>In total, 2630 men with newly diagnosed PCa were studied. Any metastatic disease was observed in 35% (931/2630) of patients. Among patients classified as having intermediate- and high-risk disease, the prevalence of metastases ranged from approximately 12% to 46%. Two RCSs further subdivided these groups. According to the NCCN, metastatic disease was observed in 5.8%, 13%, 22%, and 62% for favorable intermediate-, unfavorable intermediate-, high-, and very-high-risk PCa, respectively. Regarding the CPG, these values were 6.9%, 13%, 21%, and 60% for the corresponding risk groups.<BR><B>CONCLUSIONS: </B>This study underlines the importance of nuanced risk stratification, recommending the further subdivision of intermediate- and high-risk disease given the notable variation in the prevalence of metastatic disease. PSMA-PET/CT for primary staging should be reserved for patients with unfavorable intermediate- or higher-risk disease.<BR><B>RESULTS: </B>The use of various risk classification systems in patients with prostate cancer helps identify those at a higher risk of having metastatic disease on prostate-specific membrane antigen positron emission tomography/computed tomography for primary staging.