The CAPRA Score at 10 Years: Contemporary Perspectives and Analysis of Supporting Studies

Abstract

Tools that appraise oncologic risk are a critical component of research and clinical management of prostate cancer (PCa). We performed a PubMed/Medline search to review the concept, design, and clinical validation of the Cancer of the Prostate Risk Assessment (CAPRA) score and similar systems in the postsurgical (CAPRA-S) and primary androgen deprivation therapy (Japan CAPRA [J-CAPRA]) settings. We included reports addressing the CAPRA (n=13), CAPRA-S (n=4), and J-CAPRA (n=5) scores. External validation studies for the CAPRA score have yielded favorable clinical performance in both academic and community cohorts, with concordance index (c-index) for biochemical recurrence (BCR) after definitive treatment in the range of 0.66–0.81. Validation studies addressing the postsurgical CAPRA-S score have demonstrated favorable prediction of distant end points (c-index for BCR: 0.73–0.80; prostate cancer–specific mortality [PCSM]: 0.75–0.88). The J-CAPRA score was evaluated in 1378 men treated with primary ADT and demonstrated excellent discrimination (c-index for progression-free survival: 0.80–0.89; PCSM: 0.820–0.836; overall survival: 0.665–0.700). The CAPRA score and its derivatives have demonstrated robust clinical discrimination in a decade of validation studies. The CAPRA score and similar multivariable stratification systems are posed to replace prior older and less accurate risk group categories. Patient summaryWe addressed the development of the Cancer of the Prostate Risk Assessment (CAPRA) score, its methodology, and its supporting studies. The CAPRA score and similarly designed tools have yielded strong performance in the prediction of numerous prostate cancer end points.