UCSF-CAPRA Score Calculator
Calculates the UCSF-CAPRA score (0–10) and shows the estimated 5-year recurrence-free / disease-free survival based on the original CAPRA radical prostatectomy dataset.
The UCSF-CAPRA Score (Cancer of the Prostate Risk Assessment) is a validated, straightforward clinical tool used to predict the risk of prostate cancer recurrence and mortality. Developed by researchers at the University of California, San Francisco (UCSF), it offers a more nuanced risk stratification than the traditional D’Amico classification while remaining simpler to calculate than complex nomograms.
1. What is the CAPRA Score?
The CAPRA score is a 10-point scale derived from five clinical variables available at the time of diagnosis. It was designed using data from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) registry, which includes over 14,000 men, making it highly reflective of “real-world” clinical practice.
The primary goal of the score is to predict the likelihood of biochemical recurrence (a rising PSA after treatment), metastasis, and cancer-specific mortality.
2. Calculation of the Score
The score is calculated by assigning points to five specific clinical factors. The total sum (0–10) determines the risk category.
Scoring Table
| Variable | Level | Points |
| PSA at Diagnosis (ng/mL) | ≤ 6.0 | 0 |
| 6.1 – 10.0 | 1 | |
| 10.1 – 20.0 | 2 | |
| 20.1 – 30.0 | 3 | |
| > 30.0 | 4 | |
| Gleason Score (Biopsy) | No Grade 4 or 5 | 0 |
| Secondary Grade 4 or 5 | 1 | |
| Primary Grade 4 or 5 | 3 | |
| Clinical T-Stage | T1 or T2 | 0 |
| T3a | 1 | |
| Percent Positive Cores | < 34% | 0 |
| ≥ 34% | 1 | |
| Age at Diagnosis | < 50 years | 0 |
| ≥ 50 years | 1 |
3. Interpreting the Results
The total score categorizes patients into three distinct risk groups, which help guide treatment decisions.
Risk Categories and Outcomes
- Low Risk (Score 0–2): Patients have a high probability of 5-year disease-free survival (~85%). These individuals are often ideal candidates for Active Surveillance.
- Intermediate Risk (Score 3–5): These patients may require localized treatment, such as radical prostatectomy or radiation therapy.
- High Risk (Score 6–10): Patients have a significantly lower 5-year disease-free survival (as low as 8% for scores 7–10). Multimodal therapy is often considered.
Key Rule: For every 2-point increase in the CAPRA score, the risk of recurrence roughly doubles.
4. Clinical Significance
The CAPRA score is widely used because it addresses the limitations of older systems.
- Accuracy: It has a concordance index (c-index) of approximately 0.66 to 0.81, performing as well as or better than most computer-based nomograms.
- Versatility: While originally validated for radical prostatectomy, it has since been validated for patients receiving radiation therapy, cryosurgery, and even those choosing active surveillance.
- Prognostic Power: Beyond just recurrence, the score predicts the likelihood of the cancer spreading (metastasis) and the overall risk of dying from prostate cancer.
5. CAPRA vs. CAPRA-S
It is important to distinguish the standard CAPRA score from the CAPRA-S (Surgical) score.
- The standard CAPRA is a pre-operative tool based on biopsy and clinical exam data.
- The CAPRA-S is a post-operative tool that uses pathology data from the actual surgical specimen (e.g., surgical margins, seminal vesicle invasion) to refine the risk of recurrence after the prostate has been removed.
References
- Cooperberg MR, et al. (2005). The University of California, San Francisco Cancer of the Prostate Risk Assessment Score: a straightforward and reliable preoperative predictor of disease recurrence after radical prostatectomy. Journal of Urology, 173(6), 1938-1942.
- Cooperberg MR, et al. (2009). Risk assessment for prostate cancer metastasis and mortality at the time of diagnosis. Journal of the National Cancer Institute, 101(12), 878-887.
- May M, et al. (2007). Validity of the CAPRA score to predict biochemical recurrence-free survival after radical prostatectomy: results from a European multicenter survey. Journal of Urology, 178(5), 1957-1962.
- Cooperberg MR, et al. (2011). The CAPRA-S score: a straightforward tool for improved prediction of outcomes after radical prostatectomy. Cancer, 117(22), 5039-5046.
