In June of 2009 a team at UCSF Department of Urology announced a new prostate cancer risk assessment test that they claim can provide men and their doctors a better way of gauging long-term risks and pinpointing high risk cases of prostate cancer.

The test, as indicated by the researchers, proved accurate in predicting bone metastasis, prostate cancer-specific mortality, and all-cause mortality when localized prostate cancer is first diagnosed. The test is known as the UCSF Cancer Prostate Risk Assessment, or CAPRA.

The study used to validate the test involved a healthy 10,627 men, as reported in the June 9 online edition of the Journal of the National Cancer Institute.

“This test should help physicians and their patients predict the likely course of the individual’s disease,” said Matthew R. Cooperberg, MD, MPH, lead investigator of the study. Cooperberg, who helped develop the risk assessment test, is a prostate cancer specialist in the UCSF Department of Urology and the UCSF Helen Diller Family Comprehensive Cancer Center.

“In this study, we looked at the CAPRA score’s ability to predict mortality across multiple forms of treatment. It should help patients and clinicians decide which tumors need to be treated, and how aggressively. We also hope that in the research setting it can serve as a well-validated and consistent means of classifying men into low, intermediate and high risk groups.”

Despite that currently there have been over 100 risk assessment tests developed in recent years, none are unable to predict long-term outcomes and are applicable to just one form of treatment, rather than providing information relevant to multiple treatment modalities.

CAPRA calculates patient risk through five factors: age at diagnosis, Gleason score (a measure of how aggressive the cancer cells appear under the microscope), PSA score (prostate-specific antigen level in the blood), percentage of biopsy scores that test positive for cancer, and clinical tumor stage based on digital exam of the prostate and/or ultrasound.
“The goal of risk assessment is to find the patients at high risk of mortality and treat them aggressively, and for others to guide their treatment or surveillance plan accordingly,’’ said Cooperberg.

The CAPRA test has been independently validated in three studies. It demonstrated its ability to be accurate and consistent in predicting pathological and biochemical outcomes after a radical prostatectomy (surgery).

The study evaluated men from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a national disease registry that tracks prostate cancer patients at 40 primarily community-based urology practices across the United States.

The men in the study had all undergone a radical prostatectomy, radiation therapy, hormone therapy (ADT) or watchful waiting.

Nearly 3 percent (311) of the men developed bone metastases, 2.4 percent (251) died of prostate cancer, and 14.9 percent (1,582) died of other causes. The CAPRA score accurately predicted all three outcomes.

The study determined that with each point increase in CAPRA score, the risk of death from prostate cancer increases 39 percent; with each two-point increase in score, risk roughly doubles. The tool can predict risk up to 10 years.

“Given its high degree of accuracy and ease of calculation, the CAPRA score may prove an increasingly valuable tool for risk stratification in both the clinical practice and the research setting,’’ wrote the study authors.

Co-authors of the study were Jeanette M. Broering, RN, MS, MPH, director of data quality assurance in the UCSF Department of Urology, and Peter R. Carroll, MD, MPH, chair of the UCSF Department of Urology and director of strategic planning and clinical services at the UCSF Helen Diller Family Comprehensive Cancer Center.

So, how come we never hear about the CAPRA scores? Men are left to their own devices when trying to decide what therapy, if any, they want to pursue. Did your doctor ever mention it?

Joel T Nowak, MA, MSW