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Prostate Cancer Test Improves Prediction of Disease Course SAN FRANCISCO -- June 15, 2009 -- A new prostate cancer risk assessment test gives patients and their doctors a better way of gauging long-term risks and pinpointing high risk cases. The findings, published in the June 9 online edition of the Journal of the National Cancer Institute, showed that the test proved accurate in predicting bone metastasis, prostate cancer-specific mortality, and all-cause mortality when localised prostate cancer is first diagnosed. “This test should help physicians and their patients predict the likely course of the individual’s disease,” said lead investigator Matthew R. Cooperberg, MD, Department of Urology, University of California at San Francisco (UCSF) and the UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California. The test is known as the UCSF Cancer of the Prostate Risk Assessment, or CAPRA. “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 tumours 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.” More than 100 risk assessment tests have been developed in recent years, but most are unable to predict long-term outcomes and are applicable to just 1 form of treatment, rather than providing information relevant to multiple treatment modalities. Because of these limitations, the researchers developed the CAPRA test. It calculates patient risk through 5 factors: age at diagnosis, Gleason score, prostate-specific antigen (PSA) score, percentage of biopsy scores that test positive for cancer, and clinical tumour 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 Dr. Cooperberg. The CAPRA test has been independently validated in 3 studies as being accurate and consistent in predicting pathological and biochemical outcomes after radical prostatectomy. The present study was intended to measure the accuracy of CAPRA for its ability to predict metastasis or mortality. The study looked at 10,627 men from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE). A national disease registry launched by UCSF in 1995, it tracks prostate cancer patients at 40 primarily community-based urology practices across the US. The patients in the study had undergone radical prostatectomy, radiation therapy, androgen deprivation therapy or watchful waiting. Nearly 3% (311) of the men developed bone metastases, 2.4% (251) died of prostate cancer, and 14.9% (1,582) died of other causes. The CAPRA score accurately predicted all 3 outcomes. The study determined that with each point increase in CAPRA score, the risk of death from prostate cancer increases 39%; with each 2-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. SOURCE: University of California at San Francisco E-mail this page to a friend or colleague! To print, use this version