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Australian validation of the Cancer of the Prostate Risk Assessment Post‐Surgical score to predict biochemical recurrence after radical prostatectomy
Author(s) -
Beckmann Kerri,
O'Callaghan Michael,
Vincent Andrew,
Roder David,
Millar Jeremy,
Evans Sue,
McNeil John,
Moretti Kim
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13954
Subject(s) - prostatectomy , medicine , prostate cancer , hazard ratio , concordance , confidence interval , capra , proportional hazards model , population , biochemical recurrence , cohort , prostate specific antigen , oncology , urology , cancer , environmental health , archaeology , history
Background The Cancer of the Prostate Risk Assessment Post‐Surgical ( CAPRA ‐S) score is a simple post‐operative risk assessment tool predicting disease recurrence after radical prostatectomy, which is easily calculated using available clinical data. To be widely useful, risk tools require multiple external validations. We aimed to validate the CAPRA ‐S score in an Australian multi‐institutional population, including private and public settings and reflecting community practice. Methods The study population were all men on the South Australian Prostate Cancer Clinical Outcomes Collaborative Database with localized prostate cancer diagnosed during 1998–2013, who underwent radical prostatectomy without adjuvant therapy ( n = 1664). Predictive performance was assessed via Kaplan–Meier and Cox proportional regression analyses, Harrell's Concordance index, calibration plots and decision curve analysis. Results Biochemical recurrence occurred in 342 (21%) cases. Five‐year recurrence‐free probabilities for CAPRA ‐S scores indicating low (0–2), intermediate (3–5) and high risk were 95, 79 and 46%, respectively. The hazard ratio for CAPRA ‐S score increments was 1.56 (95% confidence interval 1.49–1.64). The Concordance index for 5‐year recurrence‐free survival was 0.77. The calibration plot showed good correlation between predicted and observed recurrence‐free survival across scores. Limitations include the retrospective nature and small numbers with higher CAPRA ‐S scores. Conclusions The CAPRA ‐S score is an accurate predictor of recurrence after radical prostatectomy in our cohort, supporting its utility in the Australian setting. This simple tool can assist in post‐surgical selection of patients who would benefit from adjuvant therapy while avoiding morbidity among those less likely to benefit.