Berlin Alejandro, Ramotar Matthew, Finelli Antonio, Liu Zhihui, Zhang Liying, Klotz Laurence, Loblaw Andrew, Vesprini Danny
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
Eur Urol Open Sci. 2025 Jul 28;79:27-31. doi: 10.1016/j.euros.2025.06.012. eCollection 2025 Sep.
STAR-CAP is a system for assigning clinical prognostic groups in prostate cancer (PC). The system was developed and validated in patients with PC managed with radical treatment (rTx) with curative intent and outperforms existing systems for risk stratification. We evaluated STAR-CAP in patients managed with active surveillance (AS) in two independent prospective cohorts (Princess Margaret Cancer Centre [PMH] and Sunnybrook Odette Cancer Centre [OCC]) between January 1, 1995, and August 1, 2021. Baseline data were evaluated and patients were categorised into nine STAR-CAP stage groups (IA-IIIC) using a point system for six variables: age, prostate-specific antigen (PSA), cT stage, cN stage, Gleason grade, and percentage positive cores. PC-specific mortality (PCSM) and progression to rTx were quantified across the STAR-CAP groups. Of the 4099 men included, 86% had cT1a-c disease and 89% had grade group 1 PC. PSA at diagnosis ranged from 4.0 to 7.9 ng/ml. Median follow-up was 5.7 yr at PMH and 10.8 yr at OCC. The proportion of patients who went on to receive rTx was 30% at PMH and 43% at OCC. The estimated 10-yr and 15-yr PCSM incidence rates were 0.4% (95% confidence interval [CI] 0.1-1.0%) and 1.1% (95% CI 0.3-2.9%) at PMH, and 1.35% (95% CI 0.79-2.18%) and 3.15% (95% CI 2.14-4.47%) at OCC, respectively. Calibration analysis showed close agreement between observed and STAR-CAP-predicted PCSM. Our external validation supports use of STAR-CAP as a singular classification system and nomenclature for more consistent decision-making across the PC continuum.
We looked at how well a tool called the STAR-CAP system predicts outcomes for men diagnosed with prostate cancer who are on active surveillance instead of undergoing immediate treatment. After 10 years and 15 years, only a small number of men in the lowest STAR-CAP categories had died from prostate cancer. STAR-CAP can help doctors and patients make better informed decisions on how to manage their prostate cancer.
STAR-CAP是一种用于对前列腺癌（PC）进行临床预后分组的系统。该系统是在接受根治性治疗（rTx）且有治愈意图的PC患者中开发并验证的，其在风险分层方面优于现有系统。我们在两个独立的前瞻性队列（玛格丽特公主癌症中心[PMH]和桑尼布鲁克奥德特癌症中心[OCC]）中，对1995年1月1日至2021年8月1日期间接受主动监测（AS）的患者进行了STAR-CAP评估。评估了基线数据，并使用一个针对六个变量的评分系统将患者分为九个STAR-CAP分期组（IA-IIIC）：年龄、前列腺特异性抗原（PSA）、cT分期、cN分期、Gleason分级和阳性核心百分比。在STAR-CAP各分组中对PC特异性死亡率（PCSM）和进展至rTx的情况进行了量化。纳入的4099名男性中，86%患有cT1a-c期疾病，89%患有1级PC。诊断时的PSA范围为4.0至7.9 ng/ml。PMH的中位随访时间为5.7年，OCC为10.8年。在PMH继续接受rTx的患者比例为30%，在OCC为43%。PMH估计的10年和15年PCSM发病率分别为0.4%（95%置信区间[CI] 0.1-1.0%）和1.1%（95%CI 0.3-2.9%），OCC分别为1.35%（95%CI 0.79-2.18%）和3.15%（95%CI 2.14-4.47%）。校准分析表明观察到的和STAR-CAP预测的PCSM之间一致性良好。我们的外部验证支持将STAR-CAP用作单一分类系统和命名法，以便在整个PC病程中进行更一致的决策。
我们研究了一种名为STAR-CAP系统的工具，对于被诊断为前列腺癌且正在接受主动监测而非立即治疗的男性，该工具预测预后的效果如何。在10年和15年后，处于最低STAR-CAP分类中的男性中只有少数死于前列腺癌。STAR-CAP可以帮助医生和患者在如何管理前列腺癌方面做出更明智的决策。
