A prediction model for early biochemical failure after radical prostatectomy based on the CAPRA-S score and the presence of secondary circulating prostate cells.

To establish a prediction model for early biochemical failure based on the CAPRA-S score and secondary circulating prostate cells.

A prospective single center study of men who underwent radical prostatectomy as monotherapy for prostate cancer.

Clinical-pathological findings were used to calculate the CAPRA-S score. 90 days after surgery blood was taken for CPC detection, mononuclear cells were obtained using differential gel centrifugation, and CPCs identified using immunocytochemistry. A CPC was defined as a cell expressing PSA but not CD45. The CPC test was defined as positive or negative. Patients were followed up for up to 5 years, biochemical failure was defined as a PSA >0. 2ng/ml. The validity of the CAPRA-S score was calibrated using partial validation, and Cox proportional hazard regression to build three models, CAPRA-S, CPC and combined models.

321 men participated, mean age 65. 5 years, after 5 years of follow up the biochemcial free survival was 98. 55%. The model using CAPRA-S showed a HR of 7. 66, that of CPC 34. 52 and the combined model showed a HR of 2. 60 for CAPRA-S and 22. 5 for CPC. Using the combined model, 23% of men changed from low risk to high risk or vice versa.

The incorporation of CPC detection significantly increased the discrimination in establishing the probability of biochemcial failure, high risk CAPRA-S patients who are negative for CPCs have a much better prognosis. The addition of CPC detection gives clinically significant information of who may be eligible for adjuvant therapy.

A single center prospective observational study of men following radical prostatectomy for prostate cancer. CAPRA-S scores were obtained from the surgical specimen analysis; secondary CPCs were detected using inmunocytochemistry three months post surgery, a positive sample contained ≥1 PSA (+) CD45 (-) staining cell/blood sample and BF was defined as a serum total PSA >0. 20ng/ml. Five year BF was determined using Cox regression analysis for models using the CAPRA-S, CPC, and combined data, they were compared using a decision analysis curve (DAC), Harrell's C concordance test and predicted versus observed survival using Kaplan-Meier curves.

321 men, mean age 65. 5yrs participated, in whom 193 (60%) had secondary CPCs detected. After 5 years of follow up the predicted biochemical free survival was 98. 6%. For the DAC, the combined CAPRA-S/CPC model was superior to both single variable models with a Harrell's C score of 0. 86. Using the combined model 23. 7% of men changed risk group.

The incorporation of CPC detection into the CAPRA-S score improved significantly its prognostic value, it identified a low risk CAPRA-S sub-group with intermediate risk and a high risk CAPRA-S subgroup with low risk. The incorporation of CPC detection into the CAPRA-s score provides clinically important information on possible treatment decisions. This article is protected by copyright. All rights reserved.

BJU international. 2015 Oct 28 [Epub ahead of print]

Nigel P Murray, Socrates Aedo, Eduardo Reyes, Nelson Orellana, Cynthia Fuentealba, Omar Jacob

Go “Beyond the Abstract” - Read an article commentary written by the authors

Hospital Carabineros of Chile, Nuñoa, 7770199, Santiago, Chile. , Faculty of Medicine, University Finis Terrae, Providencia, 7501015, Santiago, Chile. , Faculty of Medicine, Diego Portales University, Manuel Rodrıguez Sur 415, 8370179, Santiago, Chile. , Hospital DIPRECA, Las Condes, 7601003, Santiago, Chile. , Hospital Carabineros of Chile, Nuñoa, 7770199, Santiago, Chile. , Hospital Carabineros of Chile, Nuñoa, 7770199, Santiago, Chile.

PubMed

E-Newsletters

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.

Subscribe