UCSF Prostate Cancer Risk Assessment
Clinical Parameters
Years
ng/mL
%
Assessment Pending
Complete all patient, laboratory, and pathological parameters to calculate the CAPRA risk score.
Guidelines & Evidence
Verified
Last Review: 2026
When to Use
When to Use the CAPRA Score
Pre-treatment risk stratification for localized prostate cancer (cT1–T3a, N0, M0) before radical prostatectomy or radiation therapy
Predicting biochemical recurrence (BCR) after radical prostatectomy (5-year recurrence-free survival range 20–85% depending on score)
Predicting metastasis-free survival and prostate cancer-specific mortality (validated up to 15 years post-treatment)
Comparing risk across different treatment modalities (surgery vs radiation vs active surveillance) in retrospective and prospective cohorts
Selecting patients for active surveillance (CAPRA ≤ 2 associated with favorable outcomes — 85% 5-year BCR-free survival)
Stratifying patients in clinical trials (entry criteria based on CAPRA low-risk 0–2, intermediate 3–5, high 6–10)
Shared decision-making: Communicating individual recurrence risk to patients in understandable terms (""your CAPRA score is 2, meaning about 85% chance of cure with surgery"")
Post-radical prostatectomy prognostication (CAPRA score remains valid even if final pathology differs from biopsy — PSA, age, % cores are pre-treatment factors, but Gleason can be updated to post-op pathology using CAPRA-S — see below)
CAPRA vs D'Amico vs NCCN Risk Groups — Comparative Performance
| Risk Tool | Variables Included | Risk Groups | C-Index for BCR (5 years) | Advantages | Disadvantages |
|---|---|---|---|---|---|
| CAPRA (UCSF) | Age, PSA, Gleason, clinical T stage, % positive cores (5 variables total, 0–10 points, continuous) | Low (0–2), Intermediate (3–5), High (6–10) — can also be used as continuous variable | 0.66–0.70 (validation cohorts) | Most granular (10 distinct risk levels vs 3 groups), incorporates % positive cores (key predictor of tumor volume), PSA as continuous (not categorical), predicts BCR and metastasis, updated to CAPRA-S for post-op | Requires calculation (online tool or nomogram), less widely known by non-urologists compared to D'Amico, not incorporated into NCCN guidelines (uses D'Amico) |
| D'Amico (Classic, 1998) | PSA (≤10, 10–20, >20), Gleason (≤6, 7, 8–10), clinical T stage (T1c-T2a, T2b-T2c, T3a) | Low, Intermediate, High (3 groups only, some heterogeneity within groups) | 0.63–0.65 (older studies, highly variable) | Simple, widely used in NCCN guidelines, recognized by general oncologists, easy to remember (3 variables only), incorporated into NCCN algorithms | Less granular (all PSA 10–20 grouped together, all Gleason 7 grouped despite 3+4 vs 4+3 differences), does not include % positive cores (key predictor) |
| NCCN Risk Groups (2024 update) | PSA, Gleason (Grade Group 1–5), T stage (T1–T4), plus optional: % cores, genomic markers (Decipher, Oncotype) | Low, Favorable Intermediate, Unfavorable Intermediate, High, Very High (5 groups) | 0.68–0.72 (with genomic markers added, improves to 0.75–0.80) | Incorporates contemporary Grade Group (1–5), includes genomic markers for refining intermediate risk, endorsed by NCCN guidelines, widely used in US oncology | Complex (5 groups, many substages), genomic markers expensive and not universally available, still uses D'Amico framework but augmented |
Clinical Utility Beyond Biochemical Recurrence — Metastasis and Mortality Prediction
CAPRA score predicts not just biochemical recurrence (PSA rise) but clinically meaningful endpoints: metastasis (distant spread) and prostate cancer-specific mortality (PCSM). Validation study (Cooperberg et al., J Urol 2009) of 12,677 patients followed 10–15 years: (1) CAPRA 0–2: 10-year metastasis risk 2–4%, PCSM 1–2%. (2) CAPRA 3–5: 10-year metastasis risk 8–15%, PCSM 5–8%. (3) CAPRA 6–10: 10-year metastasis risk 25–40%, PCSM 20–30%. This allows risk-stratified follow-up: Low-risk: PSA every 6–12 months, imaging only if PSA rises. Intermediate-risk: PSA every 6 months, consider bone scan if PSA > 20 or rapid rise. High-risk: PSA every 3–6 months, baseline bone scan and CT abdomen/pelvis, repeat imaging if PSA rise or symptoms.
CAPRA-S (Post-Operative Score) — Refining Risk After Radical Prostatectomy
CAPRA-S (Surgery) is a validated post-radical prostatectomy risk score for recurrence. Variables: Pre-op PSA (same as CAPRA), Gleason (updated to surgical pathology, not biopsy), surgical margins (negative = 0, positive = 1), extracapsular extension (none = 0, yes = 1), seminal vesicle invasion (none = 0, yes = 2), lymph node involvement (none = 0, yes = 2). Total CAPRA-S score 0–12. Risk groups: Low (0–2): 5-year BCR-free survival 85–90%, Intermediate (3–5): 60–70%, High (6–12): 25–40%. CAPRA-S superior to CAPRA alone for post-op prognosis (c-index 0.73 vs 0.66, p < 0.001). Use CAPRA pre-treatment for initial decision-making (surgery vs radiation vs surveillance). Use CAPRA-S post-operatively to guide adjuvant therapy (radiation, androgen deprivation therapy duration). For example, CAPRA-S ≥ 6 may benefit from adjuvant radiation + ADT (based on RTOG 9601, GETUG-16).
Related Scores in Practice
In clinical practice, this assessment is frequently evaluated alongside other validated measures. Depending on the patient's presentation and specific diagnostic requirements, you may also need to utilize the Damico Risk Classification, Nccn Prostate Cancer Risk, or the Psa Density to formulate a comprehensive care plan.
Last Comprehensive Review: 2026