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Printed on 5/15/2026
For informational purposes only. This is not medical advice.
The Cancer of the Prostate Risk Assessment (CAPRA) score stratifies prostate cancer risk using PSA at diagnosis, Gleason score, clinical T-stage, percent positive biopsy cores, and age. Scores range 0–10 and predict recurrence, metastasis, and cancer-specific mortality after treatment. After treatment, monitor PSA kinetics with [PSA Doubling Time Calculator](/tools/psa-doubling-time). Assess initial PSA density with [PSA Density Calculator](/tools/psa-density). For patients undergoing chemotherapy, calculate doses with [BSA Calculator](/tools/bsa-calculator) and assess functional status with [ECOG Performance Status](/tools/ecog-performance). Monitor renal function with [eGFR Calculator](/tools/egfr-calculator).
Formula: PSA (0–4 pts) + Gleason (0–3 pts) + % Positive Cores (0–1 pt) + T Stage (0–1 pt). Total 0–10.
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Record PSA at diagnosis, primary and secondary Gleason patterns (from biopsy pathology), percentage of positive biopsy cores, clinical T-stage (from digital rectal exam and imaging), and patient age. All variables must be from the diagnostic biopsy prior to treatment.
PSA contributes 0–4 points based on level. Gleason score contributes 0–3 points based on primary pattern. Age contributes 1 point if ≥50. T-stage contributes 1 point for T3a or higher. Percent positive cores contributes 1 point for ≥34%. Total score range: 0–10.
Score 0–2: low risk — active surveillance is often appropriate. Score 3–5: intermediate risk — monotherapy or multimodal treatment. Score 6–10: high risk — aggressive multimodal therapy recommended. Use alongside [PSA Doubling Time](/tools/psa-doubling-time) post-treatment for monitoring.
Urologists, radiation oncologists
CAPRA score risk stratification guides treatment discussions — low risk supports active surveillance, intermediate risk may warrant dose-escalated radiation or nerve-sparing surgery, and high risk typically requires multimodal therapy. CAPRA frames the risk-benefit conversation for patients.
Urologic oncologists
Low CAPRA (0–2) is a key eligibility criterion for active surveillance protocols. The PRIAS, UCSF, and Johns Hopkins AS protocols all require low-risk stratification. When combined with PSAD below 0.15, biopsy Gleason 3+3, and T1c stage, CAPRA supports initial surveillance rather than immediate treatment.
Radiation oncologists
For intermediate-to-high-risk disease managed with radiation, CAPRA score informs the duration of ADT. High-risk CAPRA typically supports 24–36 months of ADT alongside dose-escalated external beam radiation, per NCCN and ESTRO guidelines.
Clinical researchers, biostatisticians
CAPRA has been validated across multiple international cohorts and treatment modalities. It provides a common risk language for comparing outcomes across institutions and clinical trials, making it one of the most reproducible prostate cancer risk stratification tools available.
Multidisciplinary oncology teams
CAPRA score provides a standardized, quantifiable risk summary for multidisciplinary tumor board discussions. It complements pathologic staging and MRI findings, facilitating structured comparison of treatment options and consistent communication across urology, radiation oncology, and medical oncology teams.
The major AS protocols (PRIAS, Johns Hopkins, UCSF CAPRA-based) all require low-risk disease. Low CAPRA alone is necessary but may not be sufficient — protocols also typically require Gleason 3+3 (Grade Group 1), ≤2 positive cores, and PSA density <0.15. Don't equate low CAPRA with AS eligibility without checking all criteria.
For intermediate-risk disease (CAPRA 3–5), genomic tissue tests (Decipher, Oncotype DX Prostate, Prolaris) provide additional prognostic information that can shift management between active surveillance, surgery, and multimodal radiation. CAPRA provides population-level risk; genomic classifiers add individual tumor biology.
CAPRA uses Gleason primary patterns (3, 4, or 5), not Grade Groups. Grade Group 1 = Gleason 3+3 (primary 3), Grade Group 2 = Gleason 3+4 (primary 3), Grade Group 3 = Gleason 4+3 (primary 4), Grade Groups 4–5 = Gleason 8–10 (primary 4 or 5). Always map correctly when pathology reports use ISUP Grade Groups.
Initial biopsies with low core sampling may undergrade or understage disease. Before finalizing CAPRA and committing to a management strategy, ensure the biopsy was comprehensive (10–12 cores minimum, targeted biopsy for suspicious MRI lesions). A re-biopsy with MRI fusion often reveals higher-grade disease, changing CAPRA from low to intermediate risk.
The ≥34% positive core threshold in CAPRA captures the difference between a single focal positive core (low volume) and extensive bilateral disease (high volume). High percentage of positive cores independently predicts worse outcomes even when Gleason score and PSA appear favorable.
UCSF-CAPRA score was derived by Cooperberg et al. (2005) in 1,439 men from the CaPSURE database and has been externally validated in multiple international cohorts across all treatment modalities. NCCN Prostate Cancer Guidelines (2024) include CAPRA as one of several recommended risk stratification tools.
Your CAPRA score stratifies your prostate cancer into risk categories that predict the likelihood of recurrence, metastasis, and cancer-specific mortality following treatment. A score of 0 to 2 indicates low-risk disease, with an estimated 85% five-year recurrence-free survival rate. These patients are often candidates for active surveillance or definitive treatment with excellent long-term outcomes. A score of 3 to 5 indicates intermediate-risk disease, with five-year recurrence-free survival of approximately 50 to 70%, where multimodal treatment (surgery with possible adjuvant radiation, or radiation with androgen deprivation) is frequently considered. A score of 6 to 10 indicates high-risk disease, with five-year recurrence-free survival of approximately 20 to 35%, where aggressive multimodal therapy is typically recommended.
The CAPRA score increases by one point for each additional risk factor, making it intuitive to understand how individual variables contribute to overall risk. A higher proportion of positive biopsy cores, higher Gleason grade, or advanced T-stage each independently worsen the prognosis and are reflected in the composite score.
The CAPRA score is used at the time of prostate cancer diagnosis, after biopsy results and staging information are available. It is appropriate for risk stratification to guide shared decision-making about treatment options — active surveillance versus surgery versus radiation therapy versus combination approaches. It is recommended by the NCCN as one of several validated risk stratification tools.
The CAPRA score is also valuable in research for standardizing patient populations across clinical trials and in quality improvement programs for comparing outcomes across institutions. It predicts outcomes across all treatment modalities, making it useful regardless of the treatment path chosen. Some clinicians also use serial CAPRA scoring to assess how risk profiles change with updated biopsy or staging information.
The CAPRA score was developed and initially validated at UCSF using a predominantly surgical cohort. While it has since been validated in multiple international cohorts and across treatment modalities (radiation, active surveillance), its predictive accuracy may vary somewhat across different populations and healthcare settings.
The score uses Gleason grading, which has been partially supplanted by the Grade Group system (ISUP 2014). While the Gleason patterns (3, 4, 5) used in CAPRA remain valid, clinicians should be aware of the evolving pathological grading landscape. Additionally, the CAPRA score does not incorporate MRI findings (PI-RADS score), genomic classifier results (Decipher, Oncotype DX Prostate), or PSMA-PET staging, all of which provide important prognostic information in contemporary practice.
The CAPRA score provides a population-level probability estimate and cannot predict individual outcomes with certainty. Two patients with the same CAPRA score may have different outcomes based on factors not captured by the score, including overall health, surgical technique, radiation dose, and tumor molecular biology.
For related assessments, see PSA Density, PSA Doubling Time and Prostate Volume.
Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.
April 21, 2026 · trust-baseline
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UrologyCalculate PSA doubling time (PSADT) to monitor prostate cancer progression after treatment. PSADT <3 months: aggressive recurrence. 3–12 months: intermediate. >12 months: lower-risk.
UrologyEstimate prostate volume from TRUS or MRI measurements using the ellipsoid formula (π/6 × L × W × H). Normal prostate is 20–30 mL; volume >40 mL suggests clinically significant BPH.