Risk stratification for prostate cancer management: value of the Cambridge Prognostic Group classification for assessing treatment allocation.
BAUS ePoster online library. Parry M. 11/10/20; 304144; P9-4
Mr. Matthew Parry
Mr. Matthew Parry
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Risk stratification for prostate cancer management: value of the Cambridge Prognostic Group classification for assessing treatment allocation.

Parry M1, Cowling T1, Sujenthiran A2, Nossiter J2, Berry B1, Cathcart P3, Aggarwal A4, Payne H5, van der Meulen J1, Clarke N6, Gnanapragasam V7
1London School of Hygiene and Tropical Medicine, London, United Kingdom, 2The Royal College of Surgeons of England, London, United Kingdom, 3Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom, 4King's College London, United Kingdom, 5University College London Hospitals, United Kingdom, 6The Christie NHS Foundation Trust and Salford Royal NHS Foundation Trust, Manchester, United Kingdom, 7University of Cambridge, United Kingdom

Background:
The five-tiered Cambridge Prognostic Group (CPG) classification is a better predictor of prostate cancer-specific mortality than the traditional three-tiered classification (low-, intermediate- and high-risk). We aimed to investigate radical treatment rates according to CPG.

Methods:
Patients diagnosed with non-metastatic prostate cancer in England, between 2014 and 2017, were identified from the National Prostate Cancer Audit database and risk stratified according to CPG. Adjusted Risk ratios (aRR) were estimated for undergoing radical treatment according to CPG, and for receiving radiotherapy for those treated radically. Funnel plots were used to display variation in radical treatment rates across hospitals.

Results:
61,999 men were included. The proportion of men receiving radical treatment increased from 11.3% in CPG1 to 78.8% in CGP4, and 73.3% in GCP5. Men in CPG3 were more likely to receive radical treatment than men in CPG2 (66.3% versus 48.4%; adjusted RR: 1.44; 95% CI 1.36-1.53 P<0.001). Radically treated men in CPG3 were also more likely to receive radiotherapy than in CPG2 (59.2% versus 43.9%; aRR: 1.18; 95% CI 1.10-1.26). Although radical treatment rates were similar in CPG4 and CPG5 (78.8% versus 73.3%; aRR: 1.01; 95% CI 0.98-1.04), more men in CPG5 had radiotherapy than in CPG4 (79.9% versus 59.1%; aRR: 1.26; 95% CI 1.12-1.40).

Conclusions:
The CPG classification distributes men in five risk groups that are about equal in size. It reveals differences in treatment practices in men with intermediate-risk disease (CPG2/CPG3) and in men with high-risk disease (CPG4/CPGP5) that are not visible when using the traditional three-tiered risk classification.
Risk stratification for prostate cancer management: value of the Cambridge Prognostic Group classification for assessing treatment allocation.

Parry M1, Cowling T1, Sujenthiran A2, Nossiter J2, Berry B1, Cathcart P3, Aggarwal A4, Payne H5, van der Meulen J1, Clarke N6, Gnanapragasam V7
1London School of Hygiene and Tropical Medicine, London, United Kingdom, 2The Royal College of Surgeons of England, London, United Kingdom, 3Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom, 4King's College London, United Kingdom, 5University College London Hospitals, United Kingdom, 6The Christie NHS Foundation Trust and Salford Royal NHS Foundation Trust, Manchester, United Kingdom, 7University of Cambridge, United Kingdom

Background:
The five-tiered Cambridge Prognostic Group (CPG) classification is a better predictor of prostate cancer-specific mortality than the traditional three-tiered classification (low-, intermediate- and high-risk). We aimed to investigate radical treatment rates according to CPG.

Methods:
Patients diagnosed with non-metastatic prostate cancer in England, between 2014 and 2017, were identified from the National Prostate Cancer Audit database and risk stratified according to CPG. Adjusted Risk ratios (aRR) were estimated for undergoing radical treatment according to CPG, and for receiving radiotherapy for those treated radically. Funnel plots were used to display variation in radical treatment rates across hospitals.

Results:
61,999 men were included. The proportion of men receiving radical treatment increased from 11.3% in CPG1 to 78.8% in CGP4, and 73.3% in GCP5. Men in CPG3 were more likely to receive radical treatment than men in CPG2 (66.3% versus 48.4%; adjusted RR: 1.44; 95% CI 1.36-1.53 P<0.001). Radically treated men in CPG3 were also more likely to receive radiotherapy than in CPG2 (59.2% versus 43.9%; aRR: 1.18; 95% CI 1.10-1.26). Although radical treatment rates were similar in CPG4 and CPG5 (78.8% versus 73.3%; aRR: 1.01; 95% CI 0.98-1.04), more men in CPG5 had radiotherapy than in CPG4 (79.9% versus 59.1%; aRR: 1.26; 95% CI 1.12-1.40).

Conclusions:
The CPG classification distributes men in five risk groups that are about equal in size. It reveals differences in treatment practices in men with intermediate-risk disease (CPG2/CPG3) and in men with high-risk disease (CPG4/CPGP5) that are not visible when using the traditional three-tiered risk classification.
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