Evaluation of Biochemical Recurrence-free Survival after Radical Prostatectomy by Cancer of the Prostate Risk Assessment Post-Surgical (CAPRA-S) Score

  • Aktas, Binhan Kagan ;
  • Ozden, Cuneyt ;
  • Bulut, Suleyman ;
  • Tagci, Suleyman ;
  • Erbay, Guven ;
  • Gokkaya, Cevdet Serkan ;
  • Baykam, Mehmet Murat ;
  • Memis, Ali
  • Published : 2015.04.03


Background: The cancer of the prostate risk assessment (CAPRA) score has been defined to predict prostate cancer recurrence based on the pre-clinical data, then pathological data have also been incorporated. Thus, CAPRA post-surgical (CAPRA-S) score has been developed based on six criteria (prostate specific antigen (PSA) at diagnosis, pathological Gleason score, and information on surgical margin, seminal vesicle invasion, extracapsular extension and lymph node involvement) for the prediction of post-surgical recurrences. In the present study, biochemical recurrence (BCR)-free probabilities after open retropubic radical prostatectomy (RP) were evaluated by the CAPRA-S scoring system and its three-risk level model. Materials and Methods: CAPRA-S scores (0-12) of our 240 radical prostatectomies performed between January 2000-May 2011 were calculated. Patients were distributed into CAPRA-S score groups and also into three-risk groups as low, intermediate and high. BCR-free probabilities were assessed and compared using Kaplan-Meier analysis and Cox proportional hazards regression. Ability of CAPRA-S in BCR detection was evaluated by concordance index (c-index). Results: BCR was present in 41 of total 240 patients (17.1%) and the mean follow-up time was $51.7{\pm}33.0$ months. Mean BCR-free survival time was 98.3 months (95% CI: 92.3-104.2). Of the patients in low, intermediate and high risk groups, 5.4%, 22.0% and 58.8% had BCR, respectively and the difference among the three groups was significant (P = 0.0001). C-indices of CAPRA-S score and three-risk groups for detecting BCR-free probabilities in 5-yr were 0.87 and 0.81, respectively. Conclusions: Both CAPRA-S score and its three-risk level model well predicted BCR after RP with high c-index levels in our center. Therefore, it is a clinically reliable post-operative risk stratifier and disease recurrence predictor for prostate cancer.


Nomogram;prostate cancer;radical prostatectomy;recurrence;survival


  1. Ceber E, Cakir D, Ogce F, et al (2008). Why do men refuse prostate cancer screening? Demographic analysis in Turkey. Asian Pac J Cancer Prev, 9, 387-90.
  2. Cooperberg MR, Pasta DJ, Elkin EP, et al (2005). 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, 173, 1938-42.
  3. Cooperberg MR, Hilton JF, Carroll PR (2011). The CAPRA-S score: a straightforward tool for improved prediction of outcomes after radical prostatectomy. Cancer, 117, 5039-46.
  4. Eser S, Yakut C, Ozdemir R, et al (2010). Cancer incidence rates in Turkey in 2006: a detailed registry based estimation. Asian Pac J Cancer Prev, 11, 1731-9.
  5. Harrell FE Jr, Lee KL, Mark DB (1996). Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med, 15, 361-87.<361::AID-SIM168>3.0.CO;2-4
  6. Hu XH, Cammann H, Meyer HA, et al (2014). Risk prediction models for biochemical recurrence after radical prostatectomy using prostate-specific antigen and Gleason score. Asian J Androl, published online.
  7. Kang DI, Chung JI, Ha HK, et al (2013). Korean prostate cancer patients have worse disease characteristics than their American counterparts. Asian Pac J Cancer Prev, 14, 6913-7.
  8. Lughezzani G, Budaus L, Isbarn H, et al (2010). Head-to-head comparison of the three most commonly used preoperative models for prediction of biochemical recurrence after radical prostatectomy. Eur Urol, 57, 562-8.
  9. Moul JW (2000). Prostate specific antigen only progression of prostate cancer. J Urol, 163, 1632-42.
  10. Punnen S, Freedland SJ, Presti JC Jr, et al (2014). Multi-institutional validation of the CAPRA-S score to predict disease recurrence and mortality after radical prostatectomy. Eur Urol, 65, 1171-7.
  11. Seo WI, Kang PM, Kang DI, et al (2014). 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. J Korean Med Sci, 29, 1212-6.
  12. Seong KT, Lim JH, Park CM, Kim HK, Park JY (2013). External validation of the cancer of the prostate risk assessment-s score in Koreans undergoing radical prostatectomy. Korean J Urol, 54, 433-6.
  13. Shariat SF, Karakiewicz PI, Roehrborn CG, Kattan MW (2008). An updated catalog of prostate cancer predictive tools. Cancer, 113, 3075-99.
  14. Tyson MD 2nd, Castle EP (2014). Racial disparities in survival for patients with clinically localized prostate cancer adjusted for treatment effects. Mayo Clin Proc, 89, 300-7.
  15. Zorlu F, Zorlu R, Divrik RT, Eser S, Yorukoglu K (2014). Prostate cancer incidence in Turkey: an epidemiological study. Asian Pac J Cancer Prev, 15, 9125-30.

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