Prostate Cancer Test Proven to Offer Early
Prediction of Bone Metastasis, Mortality
UCSF Cancer of the Prostate Risk Assessment gives patients and doctors a
better way of gauging long-term risks and pinpointing high risk cases.
June 15,
2009 A very large study, involving 10,627 men, has proven that a test
is accurate in predicting bone metastasis, prostate
cancer-specific mortality, and all-cause mortality when localized
prostate cancer is first diagnosed.
The test,
developed at the University of California, San Francisco is known as the
UCSF Cancer of the Prostate Risk Assessment, or CAPRA. The findings are
reported in the June 9 online edition of the Journal of the National
Cancer Institute.
This
test should help physicians and their patients predict the likely course
of the individuals disease, said Matthew R. Cooperberg, MD, MPH, lead
investigator of the study. Cooperberg, who helped develop the risk
assessment test, is a prostate cancer specialist in the UCSF Department
of Urology and the UCSF Helen Diller Family Comprehensive Cancer Center.
In this
study, we looked at the CAPRA scores ability to predict mortality
across multiple forms of treatment. It should help patients and
clinicians decide which tumors need to be treated, and how
aggressively, he said.
We also
hope that in the research setting it can serve as a well-validated and
consistent means of classifying men into low, intermediate and high risk
groups.
Prostate
cancer is the most common form of cancer in men and the second most
common cause of cancer death after lung cancer. This year, an estimated
192,280 men will be diagnosed with the disease, and 27,360 men will die
from it, according to the American Cancer Society.
While
prostate cancers are ultimately lethal, most men diagnosed actually die
of other causes. Because of the highly variable nature of the disease,
risk assessment to calculate the chances of cancer progression takes on
heightened importance when a patient is diagnosed, said Cooperberg. At
the time of diagnosis, only 5 percent of men have metastasis.
More than
100 risk assessment tests have been developed in recent years, but most
are unable to predict long-term outcomes and are applicable to just one
form of treatment, rather than providing information relevant to
multiple treatment modalities.
Because
of these limitations, UCSF developed the CAPRA test. It calculates
patient risk through five factors: age at diagnosis, Gleason score (a
measure of how aggressive the cancer cells appear under the microscope),
PSA score (prostate-specific antigen level in the blood), percentage of
biopsy scores that test positive for cancer, and clinical tumor stage
based on digital exam of the prostate and/or ultrasound.
The goal
of risk assessment is to find the patients at high risk of mortality and
treat them aggressively, and for others to guide their treatment or
surveillance plan accordingly, said Cooperberg.
The CAPRA
test has been independently validated in three studies as being accurate
and consistent in predicting pathological and biochemical outcomes after
radical prostatectomy (surgery to remove the prostate gland).
The UCSF
study was intended to measure the accuracy of CAPRA for its ability to
predict metastasis or mortality.
The study
looked at men from the Cancer of the Prostate Strategic Urologic
Research Endeavor (CaPSURE). A national disease registry launched by
UCSF in 1995, it tracks prostate cancer patients at 40 primarily
community-based urology practices across the United States.
The
patients in the study had undergone radical prostatectomy, radiation
therapy, androgen deprivation therapy (hormone therapy), or watchful
waiting.
Nearly 3
percent (311) of the men developed bone metastases, 2.4 percent (251)
died of prostate cancer, and 14.9 percent (1,582) died of other causes.
The CAPRA
score accurately predicted all three outcomes.
The study
determined that with each point increase in CAPRA score, the risk of
death from prostate cancer increases 39 percent; with each two-point
increase in score, risk roughly doubles. The tool can predict risk up to
10 years.
Given
its high degree of accuracy and ease of calculation, the CAPRA score may
prove an increasingly valuable tool for risk stratification in both the
clinical practice and the research setting, wrote the study authors.
Co-authors of the study were Jeanette M. Broering, RN, MS, MPH, director
of data quality assurance in the UCSF Department of Urology, and Peter
R. Carroll, MD, MPH, chair of the UCSF Department of Urology and
director of strategic planning and clinical services at the UCSF Helen
Diller Family Comprehensive Cancer Center.
UCSF is a
leading university dedicated to promoting health worldwide through
advanced biomedical research, graduate-level education in the life
sciences and health professions, and excellence in patient care.
Keep up with the latest news for senior citizens, baby
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June 15,
2009 A very large study, involving 10,627 men, has proven that a test
is accurate in predicting bone metastasis, prostate
cancer-specific mortality, and all-cause mortality when localized
prostate cancer is first diagnosed.
