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).
Last Comprehensive Review: 2026