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

J Urol. 2005 Jun;173(6):1938-42. doi: 10.1097/01.ju.0000158155.33890.e7.

Abstract

Purpose: Multivariate prognostic instruments aim to predict risk of recurrence among patients with localized prostate cancer. We devised 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 diagnosed between 1992 and 2001 who had undergone radical prostatectomy and were followed in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database, a longitudinal, community based disease registry of patients with prostate cancer. Disease recurrence was defined as prostate specific antigen (PSA) 0.2 ng/ml or greater on 2 consecutive occasions following prostatectomy or a second cancer treatment more than 6 months after surgery. The University of California, San Francisco-Cancer of the Prostate Risk Assessment (UCSF-CAPRA) score was developed using preoperative 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: A total of 210 patients (15%) had recurrence, 145 by PSA criteria and 65 by second treatment. Based on the results of the Cox analysis, points were assigned based on PSA (0 to 4 points), Gleason score (0 to 3), T stage (0 to 1), age (0 to 1) and percent of biopsy positive cores (0 to 1). The UCSF-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 UCSF-CAPRA score of 0 to 1 (95% CI 73%-92%) to 8% for a score of 7 to 10 (95% CI 0%-28%). The concordance index for the UCSF-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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adenocarcinoma / epidemiology*
  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery*
  • Aged
  • Biomarkers, Tumor / blood*
  • Biopsy, Needle / statistics & numerical data
  • California / epidemiology
  • Cohort Studies
  • Disease-Free Survival
  • Hospitals, University
  • Humans
  • Life Tables
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology*
  • Neoplasm Recurrence, Local / pathology
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Prostate / pathology
  • Prostate-Specific Antigen / blood
  • Prostatectomy / statistics & numerical data*
  • Prostatic Neoplasms / epidemiology*
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / surgery*
  • Risk Assessment

Substances

  • Biomarkers, Tumor
  • Prostate-Specific Antigen