Prognostic factors in prostate cancer - College of American Pathologists Consensus Statement 1999

Background.-Under the auspices of the College of American Pathologists, a m ultidisciplinary group of clinicians, pathologists, and statisticians consi dered prognostic and predictive factors in prostate cancer and stratified t hem into categories reflecting the strength of published evidence and takin g into account the expert opinions of the Prostate Working Group members. Materials and Methods.-Factors were ranked according to the previous Colleg e of American Pathologists categorical rankings: category I, factors proven to be of prognostic importance and useful in clinical patient management; category II, factors that have been extensively studied biologically and cl inically but whose importance remains to be validated in statistically robu st studies; and category III, all other factors not sufficiently studied to demonstrate their prognostic value. Factors in categories I and II were co nsidered with respect to variations in methods of analysis, interpretation of findings, reporting of data, and statistical evaluation. For each factor , detailed recommendations for improvement were made. Recommendations were based on the following aims: (1) increasing uniformity and completeness of pathologic evaluation of tumor specimens, (2) enhancing the quality of data collected pertaining to existing prognostic factors, and (3) improving pat ient care. Results and Conclusions.-Factors ranked in category I included preoperative serum prostate-specific antigen level, TNM stage grouping, histologic grad e as Gleason score, and surgical margin status. Category II factors include d tumor volume, histologic type, and DNA ploidy. Factors in category III in cluded perineural invasion, neuroendocrine differentiation, microvessel den sity, nuclear roundness, chromatin texture, other karyometric factors, prol iferation markers, prostate-specific antigen derivatives, and other factors (oncogenes, tumor suppressor genes, apoptosis genes, etc).