Australian validation of the Cancer of the Prostate Risk Assessment Post‐Surgical score to predict biochemical recurrence after radical prostatectomy

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Prostate cancer (PCa) is the most common cancer among Australian men1 and second most common male cancer world‐wide.2 While radical prostatectomy (RP) is an effective treatment for localized PCa, between 20 and 30% of men will experience disease progression following a prostatectomy.3 Accurate identification of men at higher risk of progression is important to ensure appropriate selection for adjuvant therapy to reduce this risk, while sparing men at low risk unnecessary treatment‐related morbidity when adjuvant therapy would be of little benefit.4 A variety of tools have been developed to assess risk of progression after prostatectomy, including look‐up tables, simple risk stratification, prediction models, nomograms and neural networks.5 Risk prediction tools have been shown to outperform clinical judgement in predicting patient outcomes.6 However, not all tools have been validated in different populations or settings other than academic or teaching hospitals.4 Furthermore, some tools are easier than others to use in the clinical setting due to their simplicity and reliance on measures available to the clinician in routine reports.5
The Cancer of the Prostate Risk Assessment Post‐Surgical (CAPRA‐S) score is a simple post‐operative risk assessment tool for predicting disease recurrence. It is easily calculated from pathology outcome data (margin status, extra‐capsular extension (ECE), seminal vesicle invasion (SVI), pathological Gleason score and nodal status) along with pre‐treatment prostate‐specific antigen (PSA) level.7 Sub‐scores are assigned to each of the post‐surgical indicators based on severity levels and summed to derive the final CAPRA‐S score. Since its development in 2011, the CAPRA‐S score has been validated in a multi‐institutional cohort in the USA,8 a large single‐institute cohort in Germany9 and smaller single surgeon/institute series in Korea10 and Turkey.12
Experts suggested that risk assessment tools be assessed within the settings in which they will be used.13 Previous validation of CAPRA‐S undertaken in the USA8 may not be applicable in the Australian context given the high proportion of African‐American men who have more aggressive PCa.14 Likewise validation in Asian populations may not be applicable to the Australian population. Furthermore, validation studies involving single institutions with specialist uro‐pathologist9 may not be relevant to real‐world community practice where specialist pathology is not always available. The aim of this study was to validate the CAPRA‐S score in a multi‐institutional community setting within Australia, using data from a longitudinal state‐based clinical registry.
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