Stratification of patients with intermediate‐risk prostate cancer

<jats:sec><jats:title>Objective</jats:title><jats:p>To identify an appropriate risk stratification system for intermediate‐risk prostate cancer (<jats:styled-content style="fixed-case">PCa</jats:styled-content>).</jats:p></jats:sec><jats:sec><jats:title>Patients and Methods</jats:title><jats:p>We reviewed the data on 1559 patients who were treated with radical prostatectomy (<jats:styled-content style="fixed-case">RP</jats:styled-content>) at our institution between 2005 and 2013 and classified them according to National Comprehensive Cancer Network (<jats:styled-content style="fixed-case">NCCN</jats:styled-content>) risk groups. For our analyses, intermediate‐risk <jats:styled-content style="fixed-case">PCa</jats:styled-content> was designated as unfavourable intermediate‐risk <jats:styled-content style="fixed-case">PCa</jats:styled-content> if it met at least one of the following two criteria: biopsy <jats:styled-content style="fixed-case">G</jats:styled-content>leason score 4 + 3 and/or presence of ≥2 intermediate‐risk criteria. All other men with intermediate‐risk <jats:styled-content style="fixed-case">PCa</jats:styled-content> were designated as having favourable intermediate‐risk disease. Postoperative outcomes, including biochemical recurrence (<jats:styled-content style="fixed-case">BCR</jats:styled-content>)‐free survival, were calculated and compared using the log‐rank test and Cox proportional hazards model.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In multivariable analysis, biopsy <jats:styled-content style="fixed-case">G</jats:styled-content>leason score 4 + 3 and multiple (≥2) intermediate‐risk criteria were observed to be independent predictors of <jats:styled-content style="fixed-case">BCR</jats:styled-content> risk among men in the intermediate‐risk group undergoing <jats:styled-content style="fixed-case">RP</jats:styled-content>. The favourable intermediate‐risk group had a significantly higher 5‐year <jats:styled-content style="fixed-case">BCR</jats:styled-content>‐free survival compared with the unfavourable intermediate‐risk group (87.5 vs 66.5%; <jats:italic>P</jats:italic> < 0.001). The unfavourable intermediate‐risk group had significantly higher 5‐year <jats:styled-content style="fixed-case">BCR</jats:styled-content>‐free survival than the high‐risk group (66.5 vs 47.9%; <jats:italic>P</jats:italic> < 0.001) while the favourable intermediate‐risk group had significantly lower 5‐year <jats:styled-content style="fixed-case">BCR</jats:styled-content>‐free survival than the low‐risk group (87.5 vs 93.5%; <jats:italic>P</jats:italic> = 0.002).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>A marked heterogeneity exists in the biochemical outcomes of contemporary patients with intermediate‐risk <jats:styled-content style="fixed-case">PCa</jats:styled-content> who undergo definitive <jats:styled-content style="fixed-case">RP</jats:styled-content>. According to biopsy <jats:styled-content style="fixed-case">G</jats:styled-content>leason score and number of intermediate‐risk criteria present, the intermediate‐risk group should be sub‐divided into those with favourable and unfavourable intermediate‐risk disease.</jats:p></jats:sec>