title: Multi-institutional validation of the CAPRA-S score to predict disease recurrence and mortality after radical prostatectomy.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  RP.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, UCSF Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
authors.forename: Sanoj
authors.initials: S
authors.lastname: Punnen
authors.affiliation: Department of Surgery, Division of Urology, Duke University, Durham, NC, USA; Urology Section, Durham Veterans Administration Medical Center, Durham, NC, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA, USA; Urology Section, Department of Surgery, Veterans Administration Medical Center, Palo Alto, CA, USA.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Presti
authors.affiliation: 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.
authors.forename: William J
authors.initials: WJ
authors.lastname: Aronson
authors.affiliation: Urology Section, Department of Surgery, Veterans Administration Medical Center, Augusta, GA, USA; Department of Surgery, Medical College of Georgia, Augusta, GA, USA.
authors.forename: Martha K
authors.initials: MK
authors.lastname: Terris
authors.affiliation: Department of Urology, University of California, San Diego, CA, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kane
authors.affiliation: Department of Urology, Oregon Health Sciences University, Portland, OR, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Amling
authors.affiliation: Department of Urology, UCSF Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Carroll
authors.affiliation: 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.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Cooperberg
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D049451:Nomograms; D011336:Probability; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology*; D018570:Risk Assessment / Q000379:methods*
chemical_list: D017430:Prostate-Specific Antigen
keywords: Nomogram; Outcomes; Prostate cancer; Radical prostatectomy