The Cancer of the Prostate Risk Assessment (CAPRA) score predicts biochemical recurrence in intermediate-risk prostate cancer treated with external beam radiotherapy (EBRT) dose escalation or low-dose rate (LDR) brachytherapy
Menée à partir de données portant sur 345 patients atteints d'un cancer de la prostate à risque intermédiaire de récidive et traités par radiothérapie externe avec escalade de doses et/ou curiethérapie par grains radioactifs à faible débit de dose, cette étude évalue la performance d'un système de score américain (CAPRA) pour prédire le risque de récidive biochimique
Objective : To study the prognostic value of the University of California, San Francisco Cancer of the Prostate Risk Assessment (CAPRA) score to predict biochemical failure (bF) after various doses of external beam radiotherapy (EBRT) and/or permanent seed low-dose rate (LDR) prostate brachytherapy (PB).
Patients and Methods : We retrospectively analysed 345 patients with intermediate-risk prostate cancer, with PSA levels of 10–20 ng/mL and/or Gleason 7 including 244 EBRT patients (70.2–79.2Gy) and 101 patients treated with LDR PB. The minimum follow-up was 3 years. No patient received primary androgen-deprivation therapy. bF was defined according to the Phoenix definition. Cox regression analysis was used to estimate the differences between CAPRA groups.
Results : The overall bF rate was 13% (45/345). The CAPRA score, as a continuous variable, was statistically significant in multivariate analysis for predicting bF (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.10–1.72, P = 0.006). There was a trend for a lower bF rate in patients treated with LDR PB when compared with those treated by EBRT ≤ 74 Gy (HR 0.234, 95% CI 0.05–1.03, P = 0.055) in multivariate analysis. In the subgroup of patients with a CAPRA score of 3–5, CAPRA remained predictive of bF as a continuous variable (HR 1.51, 95% CI 1.01–2.27, P = 0.047) in multivariate analysis.
Conclusion : The CAPRA score is useful for predicting biochemical recurrence in patients treated for intermediate-risk prostate cancer with EBRT or LDR PB. It could help in treatment decisions.
BJU International , résumé, 2013