The Cancer of the Prostate Risk Assessment (CAPRA) score predicts biochemical recurrence in intermediate‐risk prostate cancer treated with external beam radiotherapy (EBRT) dose escalation or low‐dose rate (LDR) brachytherapy

Abstract

Objective To study the prognostic value of the University of California, San Francisco Cancer of the Prostate Risk Assessment (CAPRA) score to predict biochemical failure (bF) after various doses of external beam radiotherapy (EBRT) and/or permanent seed low‐dose rate (LDR) prostate brachytherapy (PB). Patients and Methods We retrospectively analysed 345 patients with intermediate‐risk prostate cancer, with PSA levels of 10–20 ng/mL and/or Gleason 7 including 244 EBRT patients (70.2–79.2 Gy) and 101 patients treated with LDR PB. The minimum follow‐up was 3 years. No patient received primary androgen‐deprivation therapy. bF was defined according to the Phoenix definition. Cox regression analysis was used to estimate the differences between CAPRA groups. Results The overall bF rate was 13% (45/345). The CAPRA score, as a continuous variable, was statistically significant in multivariate analysis for predicting bF (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.10–1.72, P = 0.006). There was a trend for a lower bF rate in patients treated with LDR PB when compared with those treated by EBRT ≤ 74 Gy (HR 0.234, 95% CI 0.05–1.03, P = 0.055) in multivariate analysis. In the subgroup of patients with a CAPRA score of 3–5, CAPRA remained predictive of bF as a continuous variable (HR 1.51, 95% CI 1.01–2.27, P = 0.047) in multivariate analysis. Conclusion The CAPRA score is useful for predicting biochemical recurrence in patients treated for intermediate‐risk prostate cancer with EBRT or LDR PB. It could help in treatment decisions.

A decision analysis comparing 3 active surveillance protocols for the treatment of patients with low‐risk prostate cancer

“…33,34 The recent results for the ProtecT study indicate that treatment appears to have little impact on overall survival over a median follow-up of 10 years, even when biopsy is excluded from the AS protocol, as it was in the ProtecT study. Although there is evidence to suggest that these cancers present very little risk of metastasis and that delaying treatment does not increase this risk appreciably, to our knowledge fewer than 20% of men are treated with AS.…”

“…For transient procedure-related disutilities, we applied a fixed utility decrement to each patient's current utility in each model cycle for the duration of the procedure. [31][32][33][34] BCR: low-risk brachytherapy 0.0159 32,35 BCR: low-risk prostatectomy 0.0230 31,35,36 BCR: low-risk radiotherapy 0.0230 35 Metastases during BCR 0.050 (0.01) Beta 23,31,37 Metastases while under AS 0.00138 (0.000037) Beta 7,9,22,23,[37][38][39][40] Death due to prostatectomy 0.00383 (0.000018) Beta [41][42][43] Refractory metastases 0.28 44 Complications due to biopsy (major) 0.009 19,21,28 Complications due to biopsy (minor) Varies Table 28 Long-term GI AEs: brachytherapy 0.04 37 Long-term sexual AEs: brachytherapy 0.323 37,44 Long-term urinary AEs: brachytherapy 0.167 37,40,44 Long-term GI AEs: prostatectomy 0.00 37 Long-term sexual AEs: prostatectomy 0.453 37 Long-term urinary AEs: prostatectomy 0.127 37,43 Long-term GI AEs: radiotherapy 0.066 37 Long-term sexual AEs: radiotherapy 0.48 37 Long-term urinary AEs: radiotherapy 0.134 37 Exi...…”

Three linked nomograms for predicting biochemical failure in prostate cancer treated with radiotherapy plus androgen deprivation therapy

“…The prediction of biochemical recurrence (BCR) after radical prostatectomy, radiotherapy (RT), or brachytherapy is an essential issue widely analyzed in prostate cancer (PCa; [1][2][3][4][5][6]). Rising prostate-specific antigen (PSA) levels will be the result of either a local recurrence or systemic recurrence because of tumor dissemination.…”

“…Jedes Nomogramm entspricht einer Kategorie des Gleason-Score, entweder 6, 7, oder 8-10. Alle Nomogramme wurden mittels eines einzigen proportionalen Hazard-Regressionsmodells etabliert, das auch nach Monaten der ADT (0,[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] stratifiziert wurde. Die Aussagekraft dieses Modells wurde anhand von Kalibrierung, unterschiedlicher Behandlung und klinischem Nutzen analysiert.…”

Clinical risk stratification for prostate cancer: Where are we, and where do we need to go?

“…It has been validated in over a dozen independent studies, 4 including five radiation therapy cohorts (two of which were other Canadian cohorts 5,6 ). CAPRA is the only score validated to predict both biochemical and clinical endpoints, including cancer-specific mortality following both surgical and radiation modalities, with a c-index of 0.80.…”