Prostate cancer risk grouping and selection criteria based on radiation oncology perspective

Abstract

Since many decades, TNM staging has been widely used for almost all the cancer-diagnosed cases, to ensure the common language among the literature and medicine, but specifically to prostate cancer, treatment decisions have been more driven by diagnostic findings such as pretreatment PSA, age, biopsy-based Gleason score, and treatment options as well as the TNM staging. The management of prostate cancer includes a variety of approaches starting from active surveillance for very early stage. Intermediate stages could be treated with either surgery, radiotherapy, or brachytherapy with definitive intent. More locally advanced stages need combination of hormonal treatment with radiotherapy and/ or surgery. Following the several published surgical nomograms to differentiate the patients more suitable for surgery, various attempts to provide probability graphs, nomograms, lookup tables, and neural networks were published and also validated by various groups in order to clarify the heterogeneity among groups and to distinguish patient selections between surgery, external beam therapy, brachytherapy, and hormonal therapy. Among the published, more than 20 nomograms, NCCN, TNM, and D'Amico groupings are the well-known and mostly used evaluation systems. The traditional three-group and new five-group risk stratifications and the new prostate grade grouping 1-5 will be in use to predict the risk of PSA recurrence following surgery and radiotherapy. The aim of this chapter is to provide a scope on these nomograms and comparison to each other in clinical practice.