What is the rationale for the recent change in the NCCN criteria for very high risk prostate cancer?

As the new Chair of NCCN's Prostate Cancer Guidelines, I am happy to answer this.

The purpose of risk groups is not merely to be a prognostic divider, but to help guide treatment. Many systems have been developed that have greater prognostication than NCCN risk groups, such as STAR-CAP (which is supe...

It looks like the panel decided to define very high risk using eligibility criteria from the STAMPEDE M0 results (James et al., PMID 28578639) that established a benefit for intensifying systemic therapy with abiraterone. This makes a lot of sense to me because we want our risk groups to be tied to ...