The University of California, San Francisco Cancer of the Prostate Risk Assessment Score: A Straightforward and Reliable Preoperative Predictor of Disease Recurrence After Radical Prostatectomy

Abstract

Purpose-Multivariate prognostic instruments aim to predict risk of recurrence among patients with localized prostate cancer. We sought to devise a novel risk assessment tool which would be a strong predictor of outcome across various levels of risk, and which could be easily applied and intuitively understood.Materials and Methods-We studied 1,439 men who had undergone radical prostatectomy and were followed in the CaPSURE database (a longitudinal, community-based disease registry of prostate cancer patients) diagnosed between 1992 and 2001 were included. Disease recurrence was defined as prostate specific antigen (PSA) ≥0.2 ng/ml on 2 consecutive occasions following prostatectomy, or a second cancer treatment more than six months after surgery. The UCSF-CAPRA score was developed using pre-operative PSA, Gleason score, clinical T-stage, biopsy results, and age. The index was developed and validated using Cox proportional hazards and life table analyses.Results-210 patients (15%) recurred, 145 by PSA criteria and 65 by second treatment. Based on the results of the Cox analysis, points were assigned based on PSA (0-4 points), Gleason score (0-3), T stage (0-1), age (0-1), and biopsy data (0-1). The CAPRA score range is 0 to 10, with roughly double the risk of recurrence for each 2-point increase in score. Recurrence-free survival at 5 years ranged from 85% for a CAPRA score of 0-1 (95% CI 73-92%) to 8% for a score of 7-10 (95% CI 0-28%). The concordance index for the CAPRA score was 0.66. Conclusions-The UCSF-CAPRA score is a straightforward yet powerful preoperative risk assessment tool. It must be externally validated in future studies.

Extended Followup and Risk Factors for Disease Reclassification in a Large Active Surveillance Cohort for Localized Prostate Cancer

“…Clinical risk at diagnosis was calculated using CAPRA on a scale of 0 to 10 and classified using validated CAPRA groups, including lowd0 to 2, intermediated3 to 5 and high riskd6 to 10. 22 PSAD at diagnosis was calculated as PSA at diagnosis divided by prostate volume in cc as measured on confirmatory transrectal ultrasound. BxD was calculated as the total number of biopsy cores taken divided by prostate volume.…”

Contemporary Trends in Low Risk Prostate Cancer: Risk Assessment and Treatment

“…The CAPRA score is thus calculated from 0 to 10, with every 2 point increase in CAPRA score representing roughly a doubling of risk of biochemical recurrence after prostatectomy. 10,14 We analyzed temporal trends in patient distribution both among the three risk groups, with time periods defined to produce relatively even numbers of patients in each group, and to focus attention on the current decade. Within the low-risk group we further analyzed trends in individual risk factors (PSA, Gleason score, T stage, PPB), and in aggregate risk as assessed by the Kattan nomogram prediction and CAPRA scores.…”

A 17-gene Assay to Predict Prostate Cancer Aggressiveness in the Context of Gleason Grade Heterogeneity, Tumor Multifocality, and Biopsy Undersampling

“…Pretreatment risk-assessment tools [8,9] based on PSA, clinical stage, Gleason score, and other biopsy characteristics fare well in identifying patients at risk of aggressive disease but predict indolent disease for only a limited proportion of patients [10,11]. Moreover, for a substantial proportion (20-60%) of men classified as lowrisk, current pretreatment assessment tools underestimate true tumor grade and, less commonly, true stage [12][13][14].…”