Focusing on Risk Stratification in Prostate Cancer

Wayne Kuznar
Published: Monday, May 14, 2018
Dr. James L. Mohler
James L. Mohler, MD
Amid continuing concerns about overtreatment of patients with prostate cancer, the National Comprehensive Cancer Network (NCCN) has overhauled its guidelines for managing the malignancy with a greater emphasis on risk stratification for molecular testing and therapy choices. The new version of the guidelines features recommendations on germline testing, molecular testing, and initial therapy for each risk category, each of which has its own management page (Table).1

Risk stratification by family history is also emphasized, “and for the first time we finally know what a strong family history is,” Mohler said. A brother or father or multiple family members diagnosed with prostate cancer before age 60 constitutes a strong family history. “Now we’re learning more about the need to identify DNA repair gene abnormalities and also to search for Lynch syndrome, which is something that most urologists probably weren’t familiar with until recently,” he said.

Table. Risk Stratification and Staging Workup of Prostate Cancer1

Avoid Overdetection, Overtreatment

Prostate cancer guidelines are needed because overdetection leads to overtreatment. Additionally, financial incentives are such that providers are rewarded for imaging studies and treatment, and new agents treating castrationresistant prostate cancer are expensive and their optimal sequence of use is uncertain.
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