Metastatic Risk Stratification
Apply LATITUDE and CHAARTED criteria to estimate prognosis and recommend systemic therapy strategies for metastatic prostate cancer.
LATITUDE classification
High-risk disease
CHAARTED classification
High-volume disease
Management considerations
- Discuss intensified systemic therapy (e.g., ADT plus abiraterone, apalutamide, enzalutamide, or docetaxel).
- High-volume disease benefits from upfront combination therapy; assess suitability for docetaxel or triplet regimens.
- Monitor PSA every 3 months and imaging per guidelines to confirm response to first-line therapy.
- Offer genetic counselling and germline testing (BRCA1/2, ATM, etc.) to guide future targeted options.
How to Use This Calculator
Collect baseline staging data
Review CT, bone scan, or PSMA PET to determine number of bone lesions, visceral sites, and whether metastases are lymph node–only.
Input disease characteristics
Select Gleason grade, metastatic burden, and visceral involvement. Choose mHSPC vs mCRPC to tailor recommendations.
Use risk groups to guide therapy
High-risk/high-volume disease typically warrants treatment intensification (ADT plus systemic doublet or triplet therapy).
Formula
LATITUDE high-risk if ≥2 of: Gleason ≥8, ≥3 bone lesions, visceral metastases.
CHAARTED high-volume if visceral metastases or ≥4 bone lesions with ≥1 outside axial skeleton (approximated here by ≥4 bone lesions).
Outputs summarise both systems to support treatment intensification decisions.
Full Description
Risk stratification for metastatic prostate cancer uses clinicopathologic features to predict prognosis and guide systemic therapy. LATITUDE high-risk criteria (≥2 of Gleason ≥8, ≥3 bone lesions, visceral disease) identify patients who benefit from intensified ADT combinations. CHAARTED defines high-volume metastases (visceral disease or ≥4 bone lesions with extra-axial involvement) with greater overall survival benefit from docetaxel. This tool synthesises both frameworks to facilitate evidence-based decision-making and patient counselling.
Frequently Asked Questions
Does PSMA PET change the criteria?
PSMA PET detects more lesions than conventional imaging. Apply LATITUDE/CHAARTED definitions using standard imaging when comparing to clinical trial cohorts.
How should oligometastatic disease be managed?
Patients with ≤3 lesions and no visceral involvement often qualify for metastasis-directed therapy alongside systemic treatment. Consult multidisciplinary tumour board.
What if Gleason score is unavailable?
Use highest known Gleason or Grade Group. If missing, assume high-risk when other adverse features are present until pathology is obtained.
Can I use this tool for neuroendocrine variants?
Variants behave differently with poorer prognosis. Apply this tool cautiously and prioritise tailored regimens based on histology and multidisciplinary input.