Journal
JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE
Volume 113, Issue 6, Pages 727-734Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/jnci/djaa154
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Funding
- NCI/NIH/HHS [U01-CA164975, U01-CA182883, U01-CA167552, P30CA006973, P30-CA006516, P30-CA008748, U01-CA063673, UM1-CA167462, U01-CA167462, K07-CA230182]
- DOD [W81XWH-18-1-0330]
- Cancer Research UK [C8221/A19170, C8221/A29017]
- University of Hawaii Cancer Center Seed Grant
- Prostate Cancer Foundation Young Investigator Awards
- Australian National Health and Medical Research Council [209057, 1074383, 396414]
- Intramural Research Program of the National Cancer Institute, National Institutes of Health, Department of Health and Human Services
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This study aimed to develop a consensus definition of aggressive prostate cancer for etiologic epidemiologic research, with the proposal of a new definition based on clinical features. The new definition identified high-risk patients with higher predictive values for prostate cancer death within 10 years, allowing for more accurate assessment of the disease outcome.
Background: In the era of widespread prostate-specific antigen testing, it is important to focus etiologic research on the outcome of aggressive prostate cancer, but studies have defined this outcome differently. We aimed to develop an evidence-based consensus definition of aggressive prostate cancer using clinical features at diagnosis for etiologic epidemiologic research. Methods: Among prostate cancer cases diagnosed in 2007 in the National Cancer Institute's Surveillance, Epidemiology, and End Results-18 database with follow-up through 2017, we compared the performance of categorizations of aggressive prostate cancer in discriminating fatal prostate cancer within 10 years of diagnosis, placing the most emphasis on sensitivity and positive predictive value (PPV). Results: In our case population (n = 55 900), 3073 men died of prostate cancer within 10 years. Among 12 definitions that included TNM staging and Gleason score, sensitivities ranged from 0.64 to 0.89 and PPV5 ranged from 0.09 to 0.23. We propose defining aggressive prostate cancer as diagnosis of category T4 or N1 or M1 or Gleason score of 8 or greater prostate cancer, because this definition had one of the higher PPVs (0.23, 95% confidence interval = 0.22 to 0.24) and reasonable sensitivity (0.66, 95% confidence interval = 0.64 to 0.67) for prostate cancer death within 10 years. Results were similar across sensitivity analyses. Conclusions: We recommend that etiologic epidemiologic studies of prostate cancer report results for this definition of aggressive prostate cancer. We also recommend that studies separately report results for advanced category (T4 or N1 or M1), high-grade (Gleason score >= 8), and fatal prostate cancer. Use of this comprehensive set of endpoints will facilitate comparison of results from different studies and help elucidate prostate cancer etiology.
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