Factors Affecting Biochemical Recurrence After Radical Prostatectomy and Validity of CAPRA Score in Predicting Biochemical Recurrence

Year 2024, Volume: 19 Issue: 3, 136 - 144, 30.10.2024

Yusuf Arıkan , Berat Aydin Enginler , Enes Dumanli , Deniz Noyan Özlü , Büşra Emir , Mehmet Zeynel Keskin

https://doi.org/10.33719/nju1540186

Abstract

Objective: Biochemical recurrence (BCR) after prostate cancer (PCa) treatment is undesirable. It is important to inform a patient about BCR in preoperative evaluation. We aimed to demonstrate the effectiveness of the (The Prostate Cancer Risk Assessment) CAPRA score used to predict this situation in our study.
Material and Methods: The study included 348 patients who underwent Racikal Prostatectony (RP) for localized PCa. Demographic, preoperative and postoperative data were collected. CAPRA score based on preoperative total PSA value, Gleason Score, clinical T stage, percentage of positive biopsy cores and age was calculated using these data. BCR was defined as a total PSA value >0.2 ng/dL for two consecutive times after RP. Follow-up periods, recurrence status and time of recurrence were recorded.
Results: BCR positivity was detected in 60 (17.2%) of 348 patients. In univariate analyses, PSA level, lesion volume on MRI, ISUP grade, D'Amico risk classification, Seminal vesicule invasion (SVI) and CAPRA score were statistically significant in the groups. In multivariate analyses, PSA level, Neutrophile Lymphocyte Ratio, lesion dimension, intermediate risk according to D'amico classification, Extraprostatic extension (EPE) showed differences between both groups. The probability of biochemical progression-free in CAPRA risk groups shows a significant decrease in the probability of biochemical progression-free in the long term as risk increases in CAPRA risk groups: 91.4% in the low-risk group, 77.8% in the intermediate-risk group and only 61.7% in the high-risk group at 80-month follow-up.
Conclusion: CAPRA scoring system should be supported by MpMRI findings and a new nomogram should be developed with these findings.

Keywords

Keywords: CAPRA score, Radical Prostatectomy, Biochemical recurrence, Prostate Cancer

Ethical Statement

Ethics committee approval was received for this study from the ethics committee of Health Science Universty Izmir Tepecik Training and Research Hospital Decision No: 2024/07-17 Date: 19/08/2024.

Factors Affecting Biochemical Recurrence After Radical Prostatectomy and Validity of CAPRA Score in Predicting Biochemical Recurrence

Abstract

Objective: Biochemical recurrence (BCR) after prostate cancer (PCa) treatment is undesirable. It is important to inform a patient about BCR in preoperative evaluation. We aimed to demonstrate the effectiveness of the (The Prostate Cancer Risk Assessment) CAPRA score used to predict this situation in our study.
Material-Methods: The study included 348 patients who underwent Racikal Prostatectony (RP) for localized PCa. Demographic, preoperative and postoperative data were collected. CAPRA score based on preoperative total PSA value, Gleason Score, clinical T stage, percentage of positive biopsy cores and age was calculated using these data. BCR was defined as a total PSA value >0.2 ng/dL for two consecutive times after RP. Follow-up periods, recurrence status and time of recurrence were recorded.
Results: BCR positivity was detected in 60 (17.2%) of 348 patients. In univariate analyses, PSA level, lesion volume on MRI, ISUP grade, D'Amico risk classification, Seminal vesicule invasion (SVI) and CAPRA score were statistically significant in the groups. In multivariate analyses, PSA level, Neutrophile Lymphocyte Ratio, lesion dimension, intermediate risk according to D'amico classification, Extraprostatic extension (EPE) showed differences between both groups. The probability of biochemical progression-free in CAPRA risk groups shows a significant decrease in the probability of biochemical progression-free in the long term as risk increases in CAPRA risk groups: 91.4% in the low-risk group, 77.8% in the intermediate-risk group and only 61.7% in the high-risk group at 80-month follow-up.
Conclusion: CAPRA scoring system should be supported by MpMRI findings and a new nomogram should be developed with these findings.

Keywords

: CAPRA score, Radical Prostatectomy, Biochemical recurrence, Prostate Cancer

References

• 1. Van den Broeck T, van den Bergh RCN, Arfi N,et al, Prognostic Value of Biochemical Recurrence Following Treatment with Curative Intent for Prostate Cancer: A Systematic Review. Eur Urol. 2019;75(6):967-987. https://doi.org/10.1016/j.eururo.2018.10.011. Epub 2018 Oct 17.
• 2. Brockman JA, Alanee S, Vickers AJ,et al,Nomogram Predicting Prostate Cancer-specific Mortality for Men with Biochemical Recurrence After Radical Prostatectomy. Eur Urol. 2015;67(6):1160-1167. https:// doi.org/10.1016/j.eururo.2014.09.019. Epub 2014 Oct 6.
• 3. Artibani W, Porcaro AB, De Marco V, Cerruto MA, Siracusano S. Management of Biochemical Recurrence after Primary Curative Treatment for Prostate Cancer: A Review. Urol Int. 2018;100(3):251-262. https://doi. org/10.1159/000481438. Epub 2017 Nov 21.
• 4. Cooperberg MR, Hilton JF, Carroll PR. The CAPRA-S score: A straightforward tool for improved prediction of outcomes after radical prostatectomy. Cancer. 2011;117(22):5039-5046. https://doi.org/10.1002/ cncr.26169
• 5. Meurs P, Galvin R, Fanning DM, Fahey T. Prognostic value of the CAPRA clinical prediction rule: a systematic review and meta-analysis. BJU Int. 2013;111(3):427-36. https://doi.org/10.1111/j.1464-410X.2012.11400.x. Epub 2012 Aug 9.
• 6. Briganti A, Abdollah F, Nini A, et al,Performance characteristics of computed tomography in detecting lymph node metastases in contemporary patients with prostate cancer treated with extended pelvic lymph node dissection. Eur Urol. 2012 Jun;61(6):1132-8. https://doi. org/10.1016/j.eururo.2011.11.008. Epub 2011 Nov 12.
• 7. Kim WT, Kim J, Kim WJ. How can we best manage biochemical failure after radical prostatectomy? Investig Clin Urol. 2022;63(6):592-601. https:// doi.org/10.4111/icu.20220294.
• 8. Seo WI, Kang PM, Kang DI, Yoon JH, Kim W, Chung JI. Cancer of the Prostate Risk Assessment (CAPRA) Preoperative Score Versus Postoperative Score (CAPRA-S): ability to predict cancer progression and decision-making regarding adjuvant therapy after radical prostatectomy. J Korean Med Sci. 2014;29(9):1212-6. https://doi. org/10.3346/jkms.2014.29.9.1212. Epub 2014 Sep 2.
• 9. Shore ND, Moul JW, Pienta KJ, Czernin J, King MT, Freedland SJ. Biochemical recurrence in patients with prostate cancer after primary definitive therapy: treatment based on risk stratification. Prostate Cancer Prostatic Dis. 2024;27(2):192-201. https://doi. org/10.1038/s41391-023-00712-z. Epub 2023 Sep 7.
• 10. Freedland SJ, Humphreys EB, Mangold LA, Eisenberger M, Dorey FJ, Walsh PC, Partin AW. Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA. 2005 Jul 27;294(4):433-9. https://doi.org/10.1001/jama.294.4.433
• 11. Shore ND, Moul JW, Pienta KJ, Czernin J, King MT, Freedland SJ. Biochemical recurrence in patients with prostate cancer after primary definitive therapy: treatment based on risk stratification. Prostate Cancer Prostatic Dis. 2024 Jun;27(2):192-201. https://doi. org/10.1038/s41391-023-00712-z. Epub 2023 Sep 7.
• 12. Duenweg SR, Bobholz SA, Barrett MJ,et al, T2- Weighted MRI Radiomic Features Predict Prostate Cancer Presence and Eventual Biochemical Recurrence. Cancers (Basel). 2023 Sep 6;15(18):4437. https://doi.org/10.3390/cancers15184437
• 13. Falagario UG, Abbadi A, Remmers S,et al,Biochemical Recurrence and Risk of Mortality Following Radiotherapy or Radical Prostatectomy. JAMA Netw Open. 2023 Sep 5;6(9):e2332900. https://doi.org/10.1001/ jamanetworkopen.2023.32900
• 14. Tilki D, Preisser F, Graefen M, Huland H, Pompe RS. External Validation of the European Association of Urology Biochemical Recurrence Risk Groups to Predict Metastasis and Mortality After Radical Prostatectomy in a European Cohort. Eur Urol. 2019;75(6):896-900. https://doi.org/10.1016/j.eururo.2019.03.016. Epub 2019 Apr 5. PMID: 30955970.
• 15. Minardi D, Scartozzi M, Montesi L,et al,Neutrophil-tolymphocyte ratio may be associated with the outcome in patients with prostate cancer. Springerplus. 2015 Jun 12;4:255. https://doi.org/10.1186/s40064-015-1036-1
• 16. Jang WS, Cho KS, Kim MS,et al, The prognostic significance of postoperative neutrophil- to-lymphocyte ratio after radical prostatectomy for localized prostate cancer. Oncotarget. 2017 Feb 14;8(7):11778-11787. https://doi.org/10.18632/oncotarget.14349
• 17. Danacioglu YO, Turkay R, Yildiz O,et al,A Critical Analysis of the Magnetic Resonance Imaging LesionDiameter Threshold for Adverse Pathology Features. Prague Med Rep. 2023;124(1):40-51. https://doi. org/10.14712/23362936.2023.4
• 18. Manceau C, Beauval JB, Lesourd M, Almeras C, Aziza R, Gautier JR, Loison G, Salin A, Tollon C, Soulié M, Malavaud B, Roumiguié M, Ploussard G. MRI Characteristics Accurately Predict Biochemical Recurrence after Radical Prostatectomy. J Clin Med. 2020 Nov 26;9(12):3841. https://doi.org/10.3390/ jcm9123841
• 19. Sandeman K, Eineluoto JT, Pohjonen J, et al, Prostate MRI added to CAPRA, MSKCC and Partin cancer nomograms significantly enhances the prediction of adverse findings and biochemical recurrence after radical prostatectomy. PLoS One. 2020 Jul 9;15(7):e0235779. https://doi.org/10.1371/journal. pone.0235779.
• 20. Capogrosso P, Vertosick EA, Benfante NE, Sjoberg DD, Vickers AJ, Eastham JA. Can We Improve the Preoperative Prediction of Prostate Cancer Recurrence With Multiparametric MRI?. Clin Genitourin Cancer. 2019;17(4):e745-e750. https://doi.org/10.1016/j. clgc.2019.03.022
• 21. Cooperberg MR, Pasta DJ, Elkin EP,et al,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. J Urol. 2005 Jun;173(6):1938- 42. https://doi.org/10.1097/01.ju.0000158155.33890.e7. Erratum in: J Urol. 2006;175(6):2369.
• 22. Kutluhan MA, Ünal S, Özsoy E,et al,Evaluation of four pre-operative models for prediction of biochemical recurrence after radical prostatectomy in localised prostate cancer. Int J Clin Pract. 2021;75(10):e14682. https://doi.org/10.1111/ijcp.14682. Epub 2021 Aug 6.
• 23. Punnen S, Freedland SJ, Presti JC Jr, et al. Multiinstitutional validation of the CAPRA-S score to predict disease recurrence and mortality after radical prostatectomy. Eur Urol. 2014;65(6):1171-1177. https://doi.org/10.1016/j.eururo.2013.03.058
• 24. May M, Knoll N, Siegsmund M,et al,Validity of the CAPRA score to predict biochemical recurrence-free survival after radical prostatectomy. Results from a european multicenter survey of 1,296 patients. J Urol. 2007;178(5):1957-62; discussion 1962. https://doi.org/10.1016/j.juro.2007.07.043. Epub 2007 Sep 17.
• 25. Budäus L, Isbarn H, Tennstedt P,et al, Risk assessment of metastatic recurrence in patients with prostate cancer by using the Cancer of the Prostate Risk Assessment score: results from 2937 European patients. BJU Int. 2012;110(11):1714-20. https://doi.org/10.1111/j.1464- 410X.2012.11147.x. Epub 2012 Apr 23.