Dr Hwang on Risk-Stratification Factors in Nonmetastatic Prostate Cancer

Clara Hwang, MD, medical oncologist, senior staff physician, Henry Ford Health System, clinical assistant professor, Wayne State University School of Medicine, discusses risk stratification methods used to assess the risk of metastatic disease in patients with nonmetastatic prostate cancer.

One risk-stratification factor that is used to assess the risk of disease progression in patients with nonmetastatic prostate cancer is the length of time between receiving local therapy and developing disease recurrence, Hwang says. The shorter the time from initial treatment with local therapy to recurrence, the more likely a patient’s disease will progress to metastatic disease, Hwang explains.

A patient’s risk of developing metastatic disease can also be assessed using disease variables at the time of their prostate cancer presentation, according to Hwang. For example, higher Gleason scores are predictors for disease progression to metastasis, Hwang notes. Prostate-specific antigen (PSA) kinetics and PSA doubling time can also be used to assess metastatic disease risk, Hwang explains. A shorter PSA doubling time typically indicates more aggressive disease, and patients with a short PSA doubling time are more likely to progress to metastatic disease, Hwang says. Each of these factors can help determine whether a patient with nonmetastatic prostate cancer needs further treatment, Hwang emphasizes.

Deciding whether a patient with nonmetastatic prostate cancer needs treatment is important, Hwang asserts. If their disease characteristics allow, patients should be spared prostate cancer therapies because of associated adverse effects (AEs), Hwang explains. For example, if a patient who has undergone prostatectomy and develops PSA recurrence, has low PSA levels and a long PSA doubling time, and has already received salvage local therapy, they may be fit for systemic hormonal therapy, Hwang notes. In addition, treatment may be delayed in certain patients until their PSA kinetics change or their PSA doubling time shortens, Hwang says.

Similar risk-stratification strategies are used in patients with nonmetastatic castration-resistant prostate cancer (nmCRPC), according to Hwang. PSA doubling time is used to help stratify patients with nmCRPC who need further treatment after developing resistance to androgen-deprivation therapy, Hwang concludes.