Toward more personalized treatment in prostate cancer: The CCR score predicts metastasis and guides treatment decisions after radiation

The combined clinical cell-cycle risk (CCR) score uses clinical and genetic factors to assess the risk of metastasis after radiation therapy in patients with prostate cancer.

The CCR score has proven accurate in studies and can guide post-radiation treatment decisions in practice, according to Jonathan D. Tward, MD, PhD, of the University of Utah, Salt Lake City.

Dr. Tward discusses the CCR score with host David Henry, MD, in this episode.

About the score

• The CCR score combines the cell-cycle progression (CCP) score (available commercially as the Prolaris test) and the Cancer of the Prostate Risk Assessment (CAPRA) score to more precisely determine the postradiation risk for metastatic disease.
• Investigators identified a threshold for determining precise risk levels (2.112), which allows for personalized treatment decision-making based on more individual characteristics than standard risk-group categorizations, according to Dr. Tward.
• He noted that standard risk groups can include a broad range of actual risk even within a given category. Risk groups are “reasonably good at prognosticating who may or may not go on to have metastasis etc., but they’re not that good,” Dr. Tward said.

CCR score proves effective

• Dr. Tward and colleagues evaluated the CCR score in a retrospective study published in Clinical Genitourinary Cancer (https://bit.ly/3vlgUwe).
• The study included 718 men with intermediate- or high-risk localized prostate cancer who received single modality or multimodality therapy.
• Results showed that patients with CCR scores below the identified threshold (2.112) could safely forgo multimodality therapy.

CCR score bests other scoring systems

• In another study, the CCR score proved more accurate than other scoring systems.
• Dr. Tward presented findings from this study at the 2021 Genitourinary Cancers Symposium (https://bit.ly/3eBvAjM).
• The study included 741 men with intermediate- or high-risk localized prostate cancer who received single modality or multimodality therapy.
• The CCR score predicted metastasis (hazard ratio, 2.21; C-index, 0.78) and did so better than National Comprehensive Cancer Network risk groups (C-index, 0.70), the CAPRA score alone (C-index, 0.71), or the CCP score alone (C-index, 0.69).
• Dr. Tward said he has used the CCR score in his own practice for years and found it helpful.

Show notes written by Sharon Worcester, a reporter for MDedge and Medscape.

Disclosures

Both studies were funded by Myriad Genetics, the company that developed the Prolaris test. Dr. Tward disclosed relationships with Myriad Genetics and other companies. Dr. Henry has no relevant disclosures.

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