Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The UCSF Cancer of the Prostate Risk Assessment score (UCSF-CAPRA score) is designed to aid in evaluating the risk of prostate cancer progression. It requires input across five different criteria, each assessed through predefined categories. The inputs and their corresponding scoring system are detailed below:

- Age:
  - Less than 50 years: Score 0
  - 50 years or older: Score 1
- PSA at diagnosis (ng/mL):
  - 6 or less: Score 0
  - Between 6.1 and 10: Score 1
  - Between 10.1 and 20: Score 2
  - Between 20.1 and 30: Score 3
  - More than 30: Score 4
- Gleason score:
  - 1-3/1-3: Score 0
  - 1-3/4-5: Score 1
  - 4-5/1-5: Score 3
- T stage:
  - T1 or T2: Score 0
  - T3a: Score 1
- Percent biopsy cores positive for cancer:
  - Less than 34%: Score 0
  - 34% or more: Score 1

Once all the inputs have been scored, the total score is calculated by summing the scores from each category. This total score can range from 0 to 10 and is associated with an interpretation of the 5-year relapse-free survival rate. The interpretations are as follows:

- Scores 0 to 1 suggest an 85% 5-year relapse-free survival rate.
- A score of 2 indicates an 81% survival rate.
- A score of 3 corresponds to a 66% survival rate.
- A score of 4 suggests a 59% survival rate.
- A score of 5 is linked to a 60% survival rate, indicating a temporary dip but somewhat similar to the score of 4.
- A score of 6 suggests a significantly lower survival rate at 34%.
- Scores of 7 or higher predict a drastically reduced survival rate of 8%.

These interpretations help in assessing the potential severity of prostate cancer in the diagnosed individual and are intended to guide further clinical decisions.

The UCSF Cancer of the Prostate Risk Assessment score, abbreviated as UCSF-CAPRA score, is a clinical calculator used in the management of prostate cancer. This scoring system is applicable to patients diagnosed with prostate cancer and is used to predict the risk of recurrence after radical prostatectomy. The UCSF-CAPRA score takes into account factors such as the patient's age, prostate-specific antigen (PSA) level, Gleason score, percentage of biopsy cores positive for cancer, and clinical T stage. 

The clinical utility of the UCSF-CAPRA score lies in its ability to guide treatment decisions by stratifying patients into low, intermediate, and high-risk groups. It can also be used to predict the 10-year probability of prostate cancer mortality. 

There are no specific exclusion criteria for the use of the UCSF-CAPRA score. However, it is less applicable to patients who have already undergone treatment for prostate cancer, such as radiation therapy or hormone therapy, as these treatments can alter the parameters used in the score calculation.

UCSF Cancer of the Prostate Risk Assessment score (UCSF-CAPRA score)

The TNM classification system for prostate cancer is used to determine the stage of cancer based on five different factors. The inputs for the calculation include tumor classification, lymph node classification, distant metastasis, prostate-specific antigen level, and grade group. The calculator takes these inputs and determines the stage of prostate cancer according to predefined conditions.

Each input is categorized as follows:

- Tumor classification options range from "Tx" (unable to assess) to "T4" (tumor invading significant structures).
- Lymph node classification can be "Nx" (unable to assess), "N0" (no metastasis), or "N1" (presence of metastasis).
- Distant metastasis is identified as "M0" (none) to "M1c" (metastasis in other sites).
- Prostate-specific antigen (PSA) level is categorized as less than 10, between 10 and 20, or greater than or equal to 20 ng/mL.
- Grade group ranges from 1 (least severe) to 5 (most severe).

The procedural logic uses Boolean variables to check conditions:

- A-Z denote each possible input category.
- Conditions are checked using combined criteria to determine the result as "Stage I" to "Stage IVB", or state the stage cannot be fully assessed.

Example criteria include:

Stage I: Clinically inapparent tumor (C, D, or E), no lymph node metastasis (M), no distant metastasis (O), PSA level greater than or equal to 20 (U).

Stage IIA: Tumor confined within the prostate (F), no lymph node metastasis (M), no distant metastasis (O), PSA level less than 10 (S).

Stage IIIB: Tumor with extraprostatic extension (I), no lymph node metastasis (M), no distant metastasis (O), varying PSA levels and grades.

Stage IVA: Any tumor classification with regional lymph node metastasis (N), no distant metastasis (O).

Stage IVB: Any tumor classification with metastasis (P, Q, or R), varying PSA levels and grades.

The function outputs the determined stage or a prompt for more input if insufficient data is provided. Each combination follows a systematic rule-based process according to the TNM classification principles. Users must select options for all inputs to receive an accurate stage result.

The calculator in question is the TNM Classification for Prostate Cancer. TNM stands for Tumor, Nodes, and Metastases, and it is a globally recognized system used to stage different types of cancers, including prostate cancer. 

This classification system is applicable to patients diagnosed with prostate cancer. It helps clinicians to determine the extent of cancer spread, which is crucial for planning treatment and predicting prognosis. 

The TNM system for prostate cancer includes three components: T (Tumor), which describes the size and extent of the primary tumor; N (Nodes), which indicates whether the cancer has spread to nearby lymph nodes; and M (Metastases), which shows if the cancer has metastasized to other parts of the body.

There are no specific exclusion criteria for the use of the TNM classification system in prostate cancer. However, it may not be applicable or useful in patients with benign prostatic hyperplasia or other non-cancerous conditions of the prostate. It is also less useful in patients with advanced disease where the focus is on symptom management rather than curative treatment.

TNM classification for prostate cancer

The Eastern Cooperative Oncology Group (ECOG) performance status calculator is designed to evaluate a patient's functional ability and categorize it into a specific score from 0 to 5. This quantitative measure helps clinicians make informed decisions about treatment based on the patient's capacity for daily activities and self-care. Here's how it operates:

The user provides input by selecting the description that best matches the patient's current condition from a list of predefined options. These options encapsulate various levels of activity and ability:

- A patient who is "Fully active, able to carry on all pre-disease performance without restriction" is assigned a score of ECOG PS 0. This indicates that the patient is not limited in any capacity by their disease.
- If a patient is "Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, such as light housework, office work," they receive an ECOG PS 1. This means the patient can perform some self-care and work activities but faces restrictions with strenuous tasks.
- "Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours" corresponds to an ECOG PS 2. This reflects moderate impairment, where the patient is active for the majority of the day but not capable of work activities.
- A patient who is "Capable of only limited self-care, confined to bed or chair more than 50% of waking hours" gets an ECOG PS 3. This score denotes significant limitation, as the patient is mobile for less than 50% of the time and requires assistance for most activities.
- With "Completely disabled, cannot carry on any self-care, totally confined to bed or chair," the patient is categorized as ECOG PS 4, indicating severe impairment and complete dependency.
- Finally, if the patient is "Dead," they are assigned an ECOG PS 5.

These score assignments help standardize assessments, providing an objective measure of a patient's status which can be pivotal in guiding medical decisions and evaluating treatment options.

The Eastern Cooperative Oncology Group (ECOG) performance status, also known as the ECOG score, is a widely used tool in oncology to assess a patient's level of functioning in terms of their ability to care for themselves, daily activity, and physical ability (walking, working, etc.). It is applicable to patients with cancer of any type and at any stage.

The ECOG score ranges from 0 to 5, with 0 indicating fully active and able to carry on all pre-disease activities without restriction, and 5 indicating death. The score is used to determine a patient's prognosis, assess how a disease is progressing, and to determine appropriate treatment strategies. It is also often used in clinical trials to assess eligibility and to monitor patient progress.

There are no specific exclusion criteria for the use of the ECOG score, but it is important to note that it is a subjective measure and may not fully capture a patient's functional status. It is also less useful in patients with fluctuating or rapidly changing conditions.

Eastern Cooperative Oncology Group performance status (ECOG score)

The Karnofsky Performance Scale (KPS) provides a practical method to evaluate a patient's functional ability and the extent of care required based on their health status. The scale ranges from 0% to 100%, where higher percentages signify better functional capacity and health.

This tool involves selecting a descriptive statement that best reflects a patient's current condition from a predefined list. Each statement is connected to a specific KPS percentage that indicates the patient’s ability to perform daily activities and their dependency levels. Here’s how the assessment works:

- When a patient is described as "Normal, no complaints, no evidence of disease," this is assessed as KPS 100%. At this level, the individual can engage in all regular activities, including work, without needing special care.

- If a patient can "carry on normal activity" but exhibits "minor signs or symptoms of disease," they are scored at KPS 90%, indicating the capability to maintain routine activities without requiring special care.

- A description of "Normal activity with effort, some signs or symptoms of disease" aligns with KPS 80%. This suggests the patient can still carry out normal activities but might require some extra effort.

- When the condition reflects "Cares for self, unable to carry on normal activity or to do active work," it corresponds to KPS 70%. The patient can handle most personal needs independently but may need occasional assistance.

- "Requires occasional assistance but is able to care for most personal needs" is rated as KPS 60%, implying increased dependency on assistance though the patient remains mostly self-sufficient.

- At KPS 50%, for conditions described as "Requires considerable assistance and frequent medical care," the patient can live at home but needs considerable help with personal care.

- As the need for care intensifies, with descriptions like "Disabled, requires special care and assistance," the KPS drops to 40%. This marks a significant deterioration in self-care ability.

- "Severely disabled, hospital admission is indicated, death not imminent" corresponds to KPS 30%, highlighting a need for hospitalization without immediate life-threatening conditions.

- For those "Very sick," necessitating hospital admission and "active supportive treatment," the KPS is 20%, indicating critical care requirements.

- At KPS 10%, "Moribund" denotes an inability to care for oneself, with urgent need for hospital-level care and a poor prognosis.

- Lastly, "Dead" is considered as KPS 0%.

This scale is instrumental in providing a quick overview of a patient's ability to function independently and their need for medical support, thereby facilitating better care planning and resource allocation.

The Karnofsky Performance Status Scale (KPSS) is a clinical calculator used primarily in patients with cancer. It is a simple, numerical scale that measures a patient's functional status, ability to perform daily activities, and overall quality of life. The KPSS ranges from 0 (indicating death) to 100 (indicating perfect health). 

The clinical utility of the KPSS is to assess a patient's prognosis, determine appropriate treatment strategies, and monitor changes in a patient's condition over time. It is particularly useful in oncology for determining eligibility for certain treatments, such as chemotherapy or surgery, and for predicting survival outcomes. 

There are no specific exclusion criteria for the use of the KPSS. However, it is less useful in patients with non-cancer illnesses or in those with cognitive impairment who may not be able to accurately self-report their functional status.

Karnofsky Performance Scale

The TNM classification calculator for urothelial carcinoma of the prostate assesses the stage of the cancer based on three categories of inputs related to tumor characteristics: tumor classification, lymph node classification, and metastasis classification. Each input option aligns with a specific stage of cancer progression based on the established TNM staging criteria.

Inputs:
- Tumor Classification: Users select from options detailing the extent and location of the primary tumor, such as "Tx" (cannot be assessed) or "T4" (tumor invading other adjacent organs).
- Lymph Node Classification: Options include assessments of lymph node involvement, such as "Nx" (cannot be assessed) or "N2" (multiple lymph nodes involved).
- Metastasis Classification: This determines if there is distant metastasis, with options "M0" (none) or "M1" (present).

The calculator applies logical conditions to these inputs to determine the cancer stage:

1. If the tumor is "Tis pu" or "Tis pd" (carcinoma in situ) with no regional lymph node metastasis ("N0") and no distant metastasis ("M0"), it is classified as Stage 0is.
2. A "T1" tumor with "N0" and "M0" signifies Stage I.
3. "T2" with "N0" and "M0" is classified as Stage II.
4. "T3" with "N0" and "M0", or any combination of "T1", "T2", or "T3" with "N1" and "M0", results in Stage III.
5. Stage IV is assigned when:
    - "T4" with "N0" or "N1" and "M0"
    - Any "T" stage with "N2" and "M0"
    - Any "T" stage with any "N" stage and "M1".

The calculator in question is the TNM (Tumor, Node, Metastasis) Classification for Urothelial Carcinoma of the Prostate. This classification system is used specifically for patients diagnosed with urothelial carcinoma of the prostate, a type of cancer that originates in the urothelium, the tissue lining the prostate.

The TNM Classification is a globally recognized standard for staging different types of cancers. It provides a systematic and consistent method to evaluate the extent of the cancer's spread. The 'T' in TNM refers to the size and extent of the main tumor, 'N' refers to the number of nearby lymph nodes that have cancer, and 'M' refers to whether the cancer has metastasized or spread to other parts of the body.

The clinical utility of this calculator is to help clinicians determine the stage of the patient's cancer, which is crucial for prognosis and treatment planning. It can guide decisions about surgery, radiation therapy, chemotherapy, and other treatment modalities.

There are no specific exclusion criteria for the use of the TNM Classification for Urothelial Carcinoma of the Prostate. However, it is not applicable to other types of prostate cancer or to urothelial carcinoma located in other parts of

TNM classification for urothelial carcinoma of the prostate

The Modified Glasgow Prognostic Score (mGPS) is a key tool in predicting cancer outcomes, relying on the assessment of two biochemical markers: C-reactive protein (CRP) and albumin. This score helps to categorize the prognosis into three levels: good, intermediate, and poor.

To compute the mGPS:

- C-reactive protein is evaluated first. Two options are considered:  
  - If the CRP is less than or equal to 10 mg/L, it indicates lower systemic inflammation.
  - If the CRP is greater than 10 mg/L, it signifies higher inflammation levels.

- Albumin is the second marker, with two possibilities:  
  - An albumin level of less than 3.5 g/dL [35 g/L] suggests malnutrition or potential inflammatory conditions.
  - An albumin level equal to or greater than 3.5 g/dL [35 g/L] signifies a normal nutritional status and protein reserves.

The mGPS score is derived based on the following systematic interpretation:

- If CRP is <= 10 mg/L, regardless of the albumin level, the score is mGPS 0, corresponding to a good prognosis. This combination indicates a low level of inflammation, which is a favorable signal in cancer outcomes.
 
- If CRP is > 10 mg/L and albumin is >= 3.5 g/dL [35 g/L], the score is mGPS 1, associated with an intermediate prognosis. This combination suggests elevated inflammation yet with sufficient nutritional status, resulting in a moderate outlook.

- If CRP is > 10 mg/L and albumin is < 3.5 g/dL [35 g/L], the result is mGPS 2, indicating a poor prognosis. This reflects high inflammation levels coupled with low albumin, suggesting a more severe condition.

Here's a concise summary table for reference:

| C-reactive Protein | Albumin               | mGPS Score | Interpretation          |
|---------------------|-----------------------|-------------|-----------------------|
| <= 10 mg/L          | < 3.5 or >= 3.5 g/dL  | 0           | Good prognosis         |
| > 10 mg/L           | >= 3.5 g/dL           | 1           | Intermediate prognosis |
| > 10 mg/L           | < 3.5 g/dL            | 2           | Poor prognosis         |

This systematic approach enables healthcare providers to improve risk stratification in cancer patients, allowing for more tailored treatment planning.

The Modified Glasgow Prognostic Score (mGPS) is a clinical calculator used in the field of oncology to predict the prognosis of patients with cancer. It is applicable to a wide range of cancer types and stages, making it a versatile tool for clinicians. The mGPS is based on two simple, routinely measured inflammatory markers: C-reactive protein (CRP) and albumin levels. 

The clinical utility of the mGPS lies in its ability to stratify patients into different risk groups based on their inflammatory response to cancer. This can guide clinicians in making decisions about treatment strategies and follow-up plans. It can also provide valuable prognostic information to patients and their families.

There are no specific exclusion criteria for the use of the mGPS. However, it should be noted that the score may not be as accurate in patients with concurrent inflammatory or infectious conditions, as these can also affect CRP and albumin levels. Additionally, the mGPS may not be applicable to patients with rare types of cancer or those with very early or very advanced disease, as it has not been extensively validated in these groups.

Modified Glasgow Prognostic Score for cancer outcomes (mGPS)

Prostate cancer

Management of local/locoregional disease

Management of local/locoregional disease, technical considerations for radiotherapy

Multidisciplinary rehabilitation

5-alpha reductase inhibitors

5-ARIs

Management of biochemical recurrence

Management of biochemical recurrence, salvage radiotherapy

Indications for screening

Indications for screening, high-risk population

Management of castration-resistant prostate cancer

Management of castration-resistant prostate cancer, metastatic, pretreatment evaluation

Management of castration-resistant prostate cancer, metastatic, radioligand therapy

Management of biochemical recurrence, androgen deprivation therapy

Indications for screening, general population, age > 70 years

Management of local/locoregional disease, initial treatment, non-curative/palliative intent

As per EANM/EAU/ESTRO/…/SIOG 2024 guidelines, 

Management of advanced/metastatic disease

Management of advanced/metastatic disease, systemic therapy

Staging

Prostate magnetic resonance imaging

Prostate MRI

Management of local/locoregional disease, salvage therapy

Surveillance for osteoporosis

Management of castration-resistant prostate cancer, metastatic, general principles of management

Prostate biopsy

Prostate biopsy, approach

Indications for screening, general population, age 55-69 years

Monitoring for progression

Monitoring for progression, on active surveillance

Germline testing

Germline testing, positive family history

Management of castration-resistant prostate cancer, non-metastatic, observation and androgen deprivation therapy

Management of local/locoregional disease, initial treatment, locally advanced disease

Management of local/locoregional disease, technical considerations for radical prostatectomy

Management of castration-resistant prostate cancer, non-metastatic, nonsteroidal antiandrogens

Management of local/locoregional disease, initial treatment, high-risk localized disease

Management of biochemical recurrence (monitoring)

Monitoring for progression, after local treatment

Management of advanced/metastatic disease, management of metastases

Management of biochemical recurrence, evaluation

Risk assessment

Risk assessment, undiagnosed

Germline testing, metastatic disease

Prostate biopsy, indications

Prostate biopsy, reporting

Imaging for staging

Imaging for staging, clinically localized

Molecular testing

Germline testing, general indications

Prostate biopsy, technical considerations

Management of castration-resistant prostate cancer, metastatic, hormonal therapy

Monitoring for recurrence

Patients with premalignant lesions

Imaging for staging, metastatic

Indications for screening, repeat screening

Management of castration-resistant prostate cancer, metastatic, chemotherapy

Indications for screening, general considerations

Management of local recurrence

Risk assessment, newly diagnosed, localized disease

Prostate biopsy (counseling)

Management of advanced/metastatic disease (general principles of management)

Prostate biopsy (antibiotics prophylaxis)

Management of local/locoregional disease, initial treatment, intermediate-risk localized disease

Management of castration-resistant prostate cancer, metastatic, prevention of skeletal-related events

Management of castration-resistant prostate cancer, non-metastatic, pretreatment evaluation

Management of local/locoregional disease, initial treatment, low-risk localized disease

Management of local/locoregional disease, adjuvant therapy after radical prostatectomy

Management of castration-resistant prostate cancer, non-metastatic, surveillance

Management of castration-resistant prostate cancer, metastatic, PARP inhibitors

Risk assessment (newly diagnosed, advanced disease)

Updated 2024 AUA/ASTRO/SUO guidelines for the management of recurrent prostate cancer


Updated 2024 EAU guidelines for the diagnosis and management of prostate cancer


Updated 2025 ASCO guidelines for germline and somatic genomic testing in metastatic prostate cancer


Prostate cancer

Background

Overview

Guidelines

Key sources