J Korean Med Sci.  2014 Sep;29(9):1212-1216. 10.3346/jkms.2014.29.9.1212.

Cancer of the Prostate Risk Assessment (CAPRA) Preoperative Score Versus Postoperative Score (CAPRA-S): Ability to Predict Cancer Progression and Decision-Making Regarding Adjuvant Therapy after Radical Prostatectomy

Affiliations
  • 1Department of Urology, Busan Paik Hospital, Inje University, Busan, Korea. prosdoc@hanmail.net

Abstract

The University of California, San Francisco, announced in 2011 Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) score which included pathologic data, but there were no results for comparing preoperative predictors with the CAPRA-S score. We evaluated the validation of the CAPRA-S score in our institution and compare the result with the preoperative progression predictor, CAPRA score. Data of 130 patients were reviewed who underwent radical prostatectomy for localized prostate cancer from 2008 to 2013. Performance of CAPRA-S score in predicting progression free probabilities was assessed through Kaplan Meier analysis and Cox proportional hazards regression test. Additionally, prediction probability was compared with preoperative CAPRA score by logistic regression analysis. Comparing CAPRA score, the CAPRA-S score showed improved prediction ability for 5 yr progression free survival (concordance index 0.80, P = 0.04). After risk group stratification, 3 group model of CAPRA-S was superior than 3 group model of CAPRA for 3-yr progression free survival and 5-yr progression free survival (concordance index 0.74 vs. 0.70, 0.77 vs. 0.71, P < 0.001). Finally the CAPRA-S score was the more ideal predictor concerned with adjuvant therapy than the CAPRA score through decision curve analysis. The CPARA-S score is a useful predictor for disease progression after radical prostatectomy.

Keyword

Prostatic Neoplasms; Prostatectomy; Disease Progression; Recurrence

MeSH Terms

Combined Modality Therapy
Decision Making
Disease Progression
Disease-Free Survival
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Neoplasm Staging
Postoperative Period
Proportional Hazards Models
Prostate-Specific Antigen/analysis
Prostatectomy
Prostatic Neoplasms/mortality/*pathology/therapy
Retrospective Studies
Prostate-Specific Antigen

Figure

  • Fig. 1 The 5-yr biochemical-progression-free probabilities stratified by CAPRA-S score group (A) and the three-risk-group model (B) using Kaplan-Meier curves.

  • Fig. 2 Decision curve analysis comparing the CAPRA-S and CAPRA scores. The y axis shows the net increase in the proportion of patients appropriately identified for adjuvant treatment. The solid black line represents the strategy involving treating all patients with adjuvant therapy (assuming all will experience recurrence) and the solid gray line represents the strategy involving treating no patients (assuming none will experience recurrence).


Reference

1. Meltzer D, Egleston B, Abdalla I. Patterns of prostate cancer treatment by clinical stage and age. Am J Public Health. 2001; 91:126–128.
2. National Institutes of Health Consensus Development Panel. Consensus statement: the management of clinically localized prostate cancer. NCI Monogr. 1988; (7):3–6.
3. Pound CR, Partin AW, Epstein JI, Walsh PC. Prostate-specific antigen after anatomic radical retropubic prostatectomy: patterns of recurrence and cancer control. Urol Clin North Am. 1997; 24:395–406.
4. Roehl KA, Han M, Ramos CG, Antenor JA, Catalona WJ. Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol. 2004; 172:910–914.
5. Zincke H, Oesterling JE, Blute ML, Bergstralh EJ, Myers RP, Barrett DM. Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer. J Urol. 1994; 152:1850–1857.
6. Catalona WJ, Smith DS. 5-year tumor recurrence rates after anatomical radical retropubic prostatectomy for prostate cancer. J Urol. 1994; 152:1837–1842.
7. Ward JF, Zincke H, Bergstralh EJ, Slezak JM, Myers RP, Blute ML. The impact of surgical approach (nerve bundle preservation versus wide local excision) on surgical margins and biochemical recurrence following radical prostatectomy. J Urol. 2004; 172:1328–1332.
8. Bott SR, Freeman AA, Stenning S, Cohen J, Parkinson MC. Radical prostatectomy: pathology findings in 1001 cases compared with other major series and over time. BJU Int. 2005; 95:34–39.
9. Antonarakis ES, Feng Z, Trock BJ, Humphreys EB, Carducci MA, Partin AW, Walsh PC, Eisenberger MA. The natural history of metastatic progression in men with prostate-specific antigen recurrence after radical prostatectomy: long-term follow-up. BJU Int. 2012; 109:32–39.
10. Bottke D, Golz R, Störkel S, Hinke A, Siegmann A, Hertle L, Miller K, Hinkelbein W, Wiegel T. Phase 3 study of adjuvant radiotherapy versus wait and see in pT3 prostate cancer: impact of pathology review on analysis. Eur Urol. 2013; 64:193–198.
11. Budäus L, Isbarn H, Tennstedt P, Salomon G, Schlomm T, Steuber T, Haese A, Chun F, Fisch M, Michl U, et al. Risk assessment of metastatic recurrence in patients with prostate cancer by using the Cancer of the Prostate Risk Assessment score: results from 2937 European patients. BJU Int. 2012; 110:1714–1720.
12. Cooperberg MR, Freedland SJ, Pasta DJ, Elkin EP, Presti JC Jr, Amling CL, Terris MK, Aronson WJ, Kane CJ, Carroll PR. Multiinstitutional validation of the UCSF cancer of the prostate risk assessment for prediction of recurrence after radical prostatectomy. Cancer. 2006; 107:2384–2391.
13. Cooperberg MR, Hilton JF, Carroll PR. The CAPRA-S score: a straightforward tool for improved prediction of outcomes after radical prostatectomy. Cancer. 2011; 117:5039–5046.
14. Ishizaki F, Hoque MA, Nishiyama T, Kawasaki T, Kasahara T, Hara N, Takizawa I, Saito T, Kitamura Y, Akazawa K, et al. External validation of the UCSF-CAPRA (University of California, San Francisco, Cancer of the Prostate Risk Assessment) in Japanese patients receiving radical prostatectomy. Jpn J Clin Oncol. 2011; 41:1259–1264.
15. Loeb S, Carvalhal GF, Kan D, Desai A, Catalona WJ. External validation of the cancer of the prostate risk assessment (CAPRA) score in a single-surgeon radical prostatectomy series. Urol Oncol. 2012; 30:584–589.
16. Seo WI, Kang PM, Chung JI. Predictive value of the cancer of the prostate risk assessment score for recurrence-free survival after radical prostatectomy in Korea: a single-surgeon series. Korean J Urol. 2014; 55:321–326.
17. Lughezzani G, Budäus L, Isbarn H, Sun M, Perrotte P, Haese A, Chun FK, Schlomm T, Steuber T, Heinzer H, et al. Head-to-head comparison of the three most commonly used preoperative models for prediction of biochemical recurrence after radical prostatectomy. Eur Urol. 2010; 57:562–568.
18. May M, Knoll N, Siegsmund M, Fahlenkamp D, Vogler H, Hoschke B, Gralla O. Validity of the CAPRA score to predict biochemical recurrence-free survival after radical prostatectomy: results from a european multicenter survey of 1,296 patients. J Urol. 2007; 178:1957–1962.
19. Zhao KH, Hernandez DJ, Han M, Humphreys EB, Mangold LA, Partin AW. External validation of University of California, San Francisco, Cancer of the Prostate Risk Assessment score. Urology. 2008; 72:396–400.
20. Punnen S, Freedland SJ, Presti JC Jr, Aronson WJ, Terris MK, Kane CJ, Amling CL, Carroll PR, Cooperberg MR. Multi-institutional validation of the CAPRA-S score to predict disease recurrence and mortality after radical prostatectomy. Eur Urol. 2014; 65:1171–1177.
21. Cooperberg MR, Pasta DJ, Elkin EP, Litwin MS, Latini DM, Du Chane J, Carroll PR. 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; 173:1938–1942.
22. Schroeck FR, Aronson WJ, Presti JC Jr, Terris MK, Kane CJ, Amling CL, Freedland SJ. Do nomograms predict aggressive recurrence after radical prostatectomy more accurately than biochemical recurrence alone? BJU Int. 2009; 103:603–608.
23. Cooperberg MR, Broering JM, Carroll PR. Risk assessment for prostate cancer metastasis and mortality at the time of diagnosis. J Natl Cancer Inst. 2009; 101:878–887.
24. Vickers A. Prediction models in urology: are they any good, and how would we know anyway? Eur Urol. 2010; 57:571–573.
25. Messing EM, Manola J, Yao J, Kiernan M, Crawford D, Wilding G, di'Sant-Agnese PA, Trump D. Eastern Cooperative Oncology Group study EST 3886. Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol. 2006; 7:472–479.
26. Thompson IM, Tangen CM, Paradelo J, Lucia MS, Miller G, Troyer D, Messing E, Forman J, Chin J, Swanson G, et al. Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol. 2009; 181:956–962.
27. Stephenson AJ, Scardino PT, Kattan MW, Pisansky TM, Slawin KM, Klein EA, Anscher MS, Michalski JM, Sandler HM, Lin DW, et al. Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol. 2007; 25:2035–2041.
28. Seong KT, Lim JH, Park CM, Kim HK, Park JY. External validation of the cancer of the prostate risk assessment-S score in Koreans undergoing radical prostatectomy. Korean J Urol. 2013; 54:433–436.
29. Kang DI, Chung JI, Ha HK, Min K, Yoon J, Kim W, Seo WI, Kang PM, Jung SJ, Kim IY. Korean prostate cancer patients have worse disease characteristics than their American counterparts. Asian Pac J Cancer Prev. 2013; 14:6913–6917.
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