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Prostate Cancer Risk Stratification (NCCN & CAPRA)
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Clinical Context & Background
This master calculator integrates three essential tools for localized prostate cancer decision-making:
1. NCCN Risk Stratification (v4.2024)
The standard of care for assigning risk groups. It guides the choice between Active Surveillance, Surgery, or Radiation (+/- ADT).
Key Inputs: T-Stage, PSA, Grade Group, Biopsy Core stats.
2. CAPRA Score (UCSF)
A validated 0-10 point score that predicts biochemical recurrence-free survival (RFS) after radical prostatectomy. It provides a granular risk assessment often used to refine NCCN grouping.
Formula: Age + PSA + Gleason + T-Stage + % Positive Cores.
3. Epstein Criteria
Historical criteria used to identify "clinically insignificant" cancers (very low volume/grade) that are ideal candidates for Active Surveillance.
Formula Logic
Panel Logic:
1. NCCN: Hierarchical categorization (Very Low -> Very High).
2. CAPRA: Sum of weighted points (0-10).
3. Epstein: Binary check (Pass/Fail) for AS eligibility.Reference Data
| System / Category | Criteria / Score | Management / Prognosis |
|---|---|---|
| NCCN: Very Low | T1c, GG1, PSA<10, <3 cores, PSAD<0.15 | Active Surveillance |
| NCCN: Low | T1-T2a, GG1, PSA<10 | Active Surveillance |
| NCCN: Favorable Int | 1 IF, GG1-2, <50% cores | Active Surv / Brachy / RP |
| NCCN: Unfav Int | 2+ IFs OR GG3 OR >50% cores | RP or EBRT + ADT (4-6mo) |
| NCCN: High | T3a OR GG4-5 OR PSA>20 | EBRT + ADT (1.5-3y) or RP |
| NCCN: Very High | T3b-T4 OR Primary Gleason 5 | Intensified Multimodal Tx |
| --- | --- | --- |
| CAPRA: Low Risk | Score 0 - 2 | High 5y RFS (~91%) |
| CAPRA: Intermediate | Score 3 - 5 | Intermediate 5y RFS (~74%) |
| CAPRA: High Risk | Score 6 - 10 | Lower 5y RFS (~56%) |
| --- | --- | --- |
| Epstein: Insignificant | PSAD<0.15, GG1, <3 cores, <50% inv | Strong candidate for AS |
| Epstein: Significant | Fails any criteria | May require treatment |
Related Tools
Evidence-based oncology decision support. Verify with clinical guidelines.