Multi-institutional validation of the CAPRA-S score to predict disease recurrence and mortality after radical prostatectomy

Sanoj Punnen; Stephen J Freedland; Joseph C Presti Jr; William J Aronson; Martha K Terris; Christopher J Kane; Christopher L Amling; Peter R Carroll; Matthew R Cooperberg

doi:10.1016/j.eururo.2013.03.058

Multi-institutional validation of the CAPRA-S score to predict disease recurrence and mortality after radical prostatectomy

Eur Urol. 2014 Jun;65(6):1171-7. doi: 10.1016/j.eururo.2013.03.058. Epub 2013 Apr 8.

Authors

Sanoj Punnen¹, Stephen J Freedland², Joseph C Presti Jr³, William J Aronson⁴, Martha K Terris⁵, Christopher J Kane⁶, Christopher L Amling⁷, Peter R Carroll¹, Matthew R Cooperberg⁸

Affiliations

¹ Department of Urology, UCSF Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
² Department of Surgery, Division of Urology, Duke University, Durham, NC, USA; Urology Section, Durham Veterans Administration Medical Center, Durham, NC, USA.
³ Department of Urology, Stanford University School of Medicine, Stanford, CA, USA; Urology Section, Department of Surgery, Veterans Administration Medical Center, Palo Alto, CA, USA.
⁴ Urology Section, Department of Surgery, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Urology, University of California at Los Angeles School of Medicine, Los Angeles, CA, USA.
⁵ Urology Section, Department of Surgery, Veterans Administration Medical Center, Augusta, GA, USA; Department of Surgery, Medical College of Georgia, Augusta, GA, USA.
⁶ Department of Urology, University of California, San Diego, CA, USA.
⁷ Department of Urology, Oregon Health Sciences University, Portland, OR, USA.
⁸ Department of Urology, UCSF Comprehensive Cancer Center, University of California, San Francisco, CA, USA; Urology Section, Department of Surgery, Veterans Administration Medical Center, San Francisco, CA, USA. Electronic address: mcooperberg@urology.ucsf.edu.

PMID: 23587869
DOI: 10.1016/j.eururo.2013.03.058

Abstract

Background: The University of California, San Francisco, Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) score uses pathologic data from radical prostatectomy (RP) to predict prostate cancer recurrence and mortality. However, this clinical tool has never been validated externally.

Objective: To validate CAPRA-S in a large, multi-institutional, external database.

Design, setting, and participants: The Shared Equal Access Regional Cancer Hospital (SEARCH) database consists of 2892 men who underwent RP from 2001 to 2011. With a median follow-up of 58 mo, 2670 men (92%) had complete data to calculate a CAPRA-S score.

Intervention: RP.

Outcome measurements and statistical analysis: The main outcome was biochemical recurrence. Performance of CAPRA-S in detecting recurrence was assessed and compared with a validated postoperative nomogram by concordance index (c-index), calibration plots, and decision curve analysis. Prediction of cancer-specific mortality was assessed by Kaplan-Meier analysis and the c-index.

Results and limitations: The mean age was 62 yr (standard deviation: 6.3), and 34.3% of men had recurrence. The 5-yr progression-free probability for those patients with a CAPRA-S score of 0-2, 3-5, and 6-10 (defining low, intermediate, and high risk) was 72%, 39%, and 17%, respectively. The CAPRA-S c-index was 0.73 in this validation set, compared with a c-index of 0.72 for the Stephenson nomogram. Although CAPRA-S was optimistic in predicting the likelihood of being free of recurrence at 5 yr, it outperformed the Stephenson nomogram on both calibration plots and decision curve analysis. The c-index for predicting cancer-specific mortality was 0.85, with the caveat that this number is based on only 61 events.

Conclusions: In this external validation, the CAPRA-S score predicted recurrence and mortality after RP with a c-index >0.70. The score is an effective prognostic tool that may aid in determining the need for adjuvant therapy.

Keywords: Nomogram; Outcomes; Prostate cancer; Radical prostatectomy.

Publication types

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

MeSH terms

Aged
Disease-Free Survival
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Neoplasm Grading
Neoplasm Metastasis
Neoplasm Staging
Nomograms
Probability
Prostate-Specific Antigen / blood*
Prostatectomy
Prostatic Neoplasms / blood
Prostatic Neoplasms / mortality*
Prostatic Neoplasms / pathology*
Risk Assessment / methods*

Substances

Prostate-Specific Antigen

Abstract

Publication types

MeSH terms

Substances

Grants and funding