Prostate Cancer Risk Assessment and the UCSF-CAPRA Score

Risk Assessment systems are not intended to replace individualized clinician-patient decision making, but rather to provide a straightforward instrument for facilitating disease risk classification in clinical decision making and in future research.

The classification developed by D’Amico and colleagues is one of the most widely used and is a good starting point for risk assessment. This system uses PSA level (blood test), Gleason grade (microscopic appearance of the cancer cells), and T stage (size of the tumor on rectal exam and/or ultrasound) to group men as low, intermediate, or high-risk.

Low-risk: PSA less than or equal to 10, Gleason score less than or equal to 6, and clinical stage T1-2a

Intermediate risk: PSA between 10 and 20, Gleason score 7, or clinical stage T2b

High-risk: PSA more than 20, Gleason score equal or larger than 8, or clinical stage T2c-3a

Limitations: Does not account for multiple risk factors

Read more and access the risk assessment calculator here on the UCSF site

Active Surveillance: Protecting Patients From Harm by Laurence Klotz

There are few physicians around the world who have as much experience in managing men on active surveillance as Dr. Klotz and his colleagues at the Sunnybrook Center near Toronto, Canada. They have built their experience carefully over time. They have carefully integrated and studied the value of techniques like multi-parametric MRI scans, MRI-guided and MRI/TRUS fusion-guided biopsies, molecular testing, etc. into the management protocols that they use.
Klotz and his colleagues continue to believe that active surveillance can still be a reasonable option for many patients with “favorable” forms of intermediate-risk prostate cancer, especially if they have other co-morbid conditions that could lead to their deaths within the next 10 to 15 years.

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Clinically Localized Prostate Cancer Guidelines

AUA/ASTRO/SUO Guidelines

Following a prostate cancer diagnosis, patients are faced with a multitude of care options, the advisability of which is influenced by patient factors and by cancer severity or aggressiveness. The ability to categorize patients based on cancer aggressiveness is invaluable for facilitating care decisions.

Accordingly, these guidelines for the management of localized prostate cancer are structured first, to provide a clinical framework stratified by cancer severity (or risk group) to facilitate care decisions and second, to guide the specifics of implementing the selected management options.

In Scope: active surveillance, observation/watchful waiting, prostatectomy, radiotherapy, cryosurgery, high intensity focused ultrasound (HIFU) and focal therapy.

Out of Scope: Secondary or salvage treatment for localized prostate cancer that persists or recurs after primary definitive intervention, and primary treatment of locally advanced/metastatic disease.


Genomic Testing in Cancer Treatment

Genomic testing is done on cancerous tissue taken from the prostate in order to provide information about how your prostate cancer might behave. By looking at the genetic makeup of the cancer, these tests may help predict whether your prostate cancer grows slowly or aggressively.

Genomic testing can be performed on both biopsy tissue and on tissue from an entire prostate following a prostatectomy.

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