High-Risk vs Very High-Risk Prostate Cancer Outcomes
Risk stratification is central to treatment planning in nonmetastatic prostate cancer, yet the real-world impact of separating high risk from very high risk has been less clear in patients who do not undergo surgery. In a retrospective cohort of 81 patients treated without prostatectomy, investigators compared baseline features, early PSA responses, and long-term outcomes between high risk (n=24) and very high risk (n=57) groups.
At diagnosis, the very high-risk group presented with higher PSA levels, worse Gleason scores, and more advanced clinical stage than the high-risk group. Despite these baseline differences, early biochemical response did not distinguish the cohorts. PSA responses at three and six months were reported as similar, suggesting that short-term PSA change may not fully reflect the aggressiveness captured by very high-risk classification.
