尽管官方前列腺癌T分期标准集中在数字直肠检查（DRE）结果上，但医生们越来越依赖于经直肠超声（TRUS）和磁共振成像（MRI）来定义实用的临床分期以指导管理。我们评估了将影像学结果纳入T分期对于一个经过验证的预后工具的性能的影响。纳入了在2000-2019年诊断为前列腺癌、在DRE和影像（TRUS / MRI）上均为cT3a或以下阶段的患者。UCSF-CAPRA评分有两种计算方式：（1）纳入DRE为基础的T分期和（2）纳入影像为基础的T分期。我们评估了两种方法的风险变化以及CAPRA（通过两种方法）与生化复发（BCR）的关联，使用未经调整和调整的Cox比例危险模型。使用时变曲线下面积（AUC）和决策曲线分析评估模型识别和净效益。纳入了2222名男性患者，在影像为基础的分期中，377人（17％）的CAPRA评分增加（P＜0.01）。以DRE为基础（HR 1.54；95％CI 1.48-1.61）和以影像为基础（HR 1.52；95％CI 1.46-1.58）的CAPRA评分预测复发的准确性相当，具有类似的识别和决策曲线分析。在多变量Cox回归中，诊断时DRE阳性（HR 1.29；95％CI 1.09-1.53）和以影像为基础的临床T3 / 4病变（HR 1.72；95％CI 1.43-2.07）独立与BCR相关。无论是使用基于影像的分期还是以DRE为基础的分期，CAPRA评分仍然准确可靠，具有较小差异并且与BCR具有类似的关联。每种检测方式的分期信息均可用于CAPRA评分的计算，并仍然可靠地预测BCR的风险。

Although official T-staging criteria for prostate cancer center on digital rectal examination (DRE) findings, providers increasingly rely on transrectal ultrasonography (TRUS) and magnetic resonance imaging (MRI) to define pragmatic clinical stage to guide management. We assessed the impact of incorporating imaging findings into T-staging on performance of a well-validated prognostic instrument.Patients who underwent radical prostatectomy for prostate cancer diagnosed between 2000-2019 with stage ≤cT3a on both DRE and imaging (TRUS/MRI) were included. The UCSF-CAPRA score was computed 2 ways: (1) incorporating DRE-based T-stage and (2) incorporating imaging-based T-stage. We assessed for risk changes across the 2 methods and associations of CAPRA (by both methods) with biochemical recurrence (BCR), using unadjusted and adjusted Cox proportional hazards models. Model discrimination and net benefit were assessed with time-dependent area under the curve (AUC) and decision curve analysis, respectively.Of 2222 men included, 377 (17%) increased in CAPRA score with imaging-based staging (P < .01). DRE-based (HR 1.54; 95% CI 1.48-1.61) and imaging-based (HR 1.52; 95% CI 1.46-1.58) CAPRA scores were comparably accurate for predicting recurrence with similar discrimination and decision curve analyses. On multivariable Cox regression, positive DRE at diagnosis (HR 1.29; 95% CI 1.09-1.53) and imaging-based clinical T3/4 disease (HR 1.72; 95% CI 1.43-2.07) were independently associated with BCR.The CAPRA score remains accurate whether determined using imaging-based staging or DRE-based staging, with relatively minor discrepancies and similar associations with BCR. Staging information from either modality can be used in the CAPRA score calculation and still reliably predict risk of BCR.