Background: Prostate carcinoma provides a wide spectrum for risk of death from the disease and clinicians have long sought methods to predict the outcome accurately in individual patients. Traditional prognostic factors, such as histologic grade and stage, remain valuable. Additional clinical and laboratory studies may add to the precision of predicting the natural history of the disease or response to therapy.
Methods: A review of the literature on current, well accepted prognostic factors for prostate carcinoma and evolving methodology for the incorporation of new factors was conducted.
Results: The most widely used current prognostic factors for survival of patients with prostate carcinoma include clinical and pathologic stage, histologic grade, prostate specific antigen (PSA) level, age, and comorbidity. DNA ploidy has been extensively studied on radical prostatectomy specimens and appears valuable, but is not widely employed. The utility of DNA ploidy on biopsy specimens is less certain because of both methodologic issues and heterogeneity within the tumor. The statistical tools used to identify and validate new prognostic factors are critical and new techniques are sought to incorporate several independent factors into a prognostic score or index for an individual patient.
Conclusions: Current prognostic factors for prostate carcinoma provide important information for patient care and research. However, new methods to define pretreatment prognosis and needed to assist clinicians and patients in making therapeutic choices for prostate carcinoma. The ideal method with which to incorporate the information attained from anatomic stage, histologic grade, PSA level, age, and comorbidity into a manageable prognostic score is uncertain and studies on this topic should be a high priority research objective.