Can CAPRA scores predict risk of metastasis and death at diagnosis?

At the annual meeting of the American Urological Association this year, Cooperberg and colleagues introduced the idea that the Cancer of the Prostate Risk Assessment (CAPRA) score might be capable of predicting risk for prostate cancer metastasis and death based on pretreatment, clinical information. We reported on their presentation at the time, noting some concerns about the potential accuracy of the model.

There are many different tools available today to predict risks associated with prostate cancer  — from the well known Partin tables and Kattan nomograms, used to predict outcomes after specific types of treatment, to the prostate cancer calculator used to predict the probability of a positive biopsy based on a variety of clinical indicators. Most of these tools are useful in predicting risk for biochemical recurrence of disease after first-line treatment or metastasis after treatment failure. As far as we are aware, this is the first time that anyone has suggested that the CAPRA score could be used to predict risk of clinically significant, advanced prostate cancer on the basis of pretreatment data.

The CAPRA score was initially introduced as a prostate cancer risk tool in 2006, in another publication by Cooperberg and colleagues from multiple centers across the country.

In their recent publication, updated since the earlier AUA presentation, Cooperberg et al. report on the use of data from the 10,627 men with clinically localized prostate cancer in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry, who underwent one of five basic types of management — radical prostatectomy, radiation therapy (external beam or interstitial), androgen deprivation monotherapy, or watchful waiting/active surveillance — and who also had at least 6 months of follow-up after treatment.

CAPRA scores were calculated at diagnosis based on each patient’s PSA level, Gleason score, percentage of biopsy cores positive for cancer, clinical tumor stage, and age at diagnosis.

Analysis of the available data showed that:

  • 311/10,627 patients (2.9 percent) developed bone metastases.
  • 251/10,627 patients (2.4 percent) died of prostate cancer.
  • 1,582/10,627 patients (14.9 percent) died of other causes.
  • Each single-point increase in the CAPRA score was associated with increased risk for
    • Bone metastases (hazard ratio [HR]  = 1.47)
    • Prostate cancer-specific mortality (HR = 1.39)
    • All-cause mortality (HR= 1.13)
  • The CAPRA score was relatively accurate for predicting metastases, cancer-specific mortality, and all-cause mortality.

The authors conclude that, “In a large cohort of patients with clinically localized prostate cancer who were managed with one of five primary modalities, the CAPRA score predicted clinical prostate cancer endpoints with good accuracy. These results support the value of the CAPRA score as a risk assessment and stratification tool for both research studies and clinical practice.”

The “New” Prostate Cancer InfoLink is concerned, however, whether the patients in the CaPSURE database are a sufficiently diverse patient population on which to base a validation of the CAPRA score as being an accurate predictor of such long-term risk. We would like to see these data validated using at least one other large database before making the leap that is implied — that we can predict a man’s risk of prostate cancer metastasis and death with accuracy based on pre-treatment data.

4 Responses

  1. My husband had prostate cancer diagnosed and treated 20 years ago and it returned 8 years ago; then he had radiation. Now it returned 8 months ago, and 6 months ago he had a PSA of 96; 6 months later his PSA was 186. What can you tell me about that? He won’t have another PSA and he won’t go to a doctor.

    He has no other physical problems and he is 94. His uncle lived to be 96.

  2. Dear Mrs. Severns:

    If I am understanding you correctly, your husband is now 94 and has a PSA that is doubling about ever 6 months. Yes?

    I can understand why he doesn’t want to see a doctor, but he is at risk for severe bone pain associated with metastatic prostate cancer if he does not get further treatment. Appropriate therapy could drop his PSA back to a very low level aand let him live out the rest of his life without any further significant risks from metastatic disease.

  3. Do you know whether there is an online tool to calculate the CAPRA score?

  4. Dear Jan:

    You really don’t need an online tool to calculate a CAPRA score. That is one of it’s benefits. You just have to be able to add!

    Click here to see the simple explanation of how to calculate a CAPRA score.

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