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Nhs Prostate Cancer Risk Calculator

Note On Men Of African Descent

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The calculations do not specifically apply to men of African descent because insufficient numbers were available for inclusion in the original European study to obtain meaningful data. However, as this group of men have a genetically higher risk of developing prostate cancer, you may find the information provided by Prostate Cancer UK a useful source of specific help and guidance.

This does not mean the calculators may not be useful to you if you are over 55. But caution is needed because the calculator may underestimate your risk of prostate cancer.

As part of the European Randomized Study of Screening for Prostate Cancer, PSA test results from more than 20,000 men in the Rotterdam area were assessed and monitored over a twelve-year period. From this group, 6,288 men aged 55-74 met the strict criteria for inclusion in the separate risk calculator project.

These men also had two extra diagnostic tests a rectal examination and an ultrasound to check for abnormalities and measure the volume of their prostate gland. Out of this group, 29% required additional investigations. Once these had been completed, only 6% were found to have prostate cancer .

Table showing results of this cancer detection study

Medical Process

What Are The Symptoms Of Prostate Cancer

The NHS reiterates the warning that prostate cancer tends to develop slowly, which means there may be no signs for many years.

It adds that symptoms do not usually appear until the prostate is large enough to affect the urethra, which may cause signs such as:

  • an increased need to urinate
  • straining while you urinate

Evidence Based On Worlds Largest Prostate Cancer Screening Study

Aged 55-74, these were men from Rotterdam in The Netherlands, already taking part in the European Randomized Study of Screening for Prostate Cancer. The ERSPC is the worlds largest study to find out whether the early detection of cancer by means of prostate specific antigen testing could save lives. The Prostate Cancer Risk Calculator applies to men aged 55-74. Younger men have a much lower chance of being diagnosed with prostate cancer and this age group was therefore not included in the ERSPC study on which the data has been based.

For further information: Prostate Cancer Risk Calculator verification data and ERSPC published findings

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Other Types Of Prostate Screening Methods

Elevated PSA levels may help your doctor decide when to recommend a prostate MRI. Prostate MRIs with IV contrast can also be a part of your prostate cancer screening routine while youre still healthy.

Digital rectal examinations are another type of screening that examines changes manually by palpating the gland via the rectum.

Since some cancer is small and difficult to feel, results of a DRE may be inconsistent. DRE also has the potential to cause an elevated PSA.

Your Prostate Cancer Risk Calculator

Apps

The Prostate Cancer Risk Calculator has been designed to help you, and the health professionals looking after you. There are eight different calculators and the first two are designed for individual use without any medical knowledge.

You can first assess your general risk by using Risk Calculator 1 which takes into account your age, family history and urinary symptoms.

What is PSA and why is it important?You may already have had a simple test to measure the level of prostate specific antigen in your blood. The chance of having prostate cancer goes up as the level increases. Once you know your PSA level, you can then use Risk Calculator 2 . It will help you make a more informed decision about whether it would be wise to undergo further tests.

Even if your PSA is higher than normal, it does not mean you have prostate cancer, because other diseases of the prostate may increase its level. It is important to know that some cancers are slow growing, cause minimal symptoms and are not life threatening.

When you have this information, you may want to discuss the findings with your doctor. This may lead to being referred for more specialist testing and risk calculators 3, 4, 5 and 6 are for use by your urologist at different stages of the testing process.

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Were Backing Prostate Cancer Uk & Nhs Englands New Campaign Encouraging Men To Use The 30

Prostate cancer is more common than you think. Its the most common cancer in men. 1 in 8 men will get prostate cancer.

That could be a dad, uncle, brother, partner or best friend. Its why Prostate Cancer UK and the NHS have joined forces to launch a campaign to find the 14,000 men who have not started treatment for prostate cancer since the beginning of the pandemic.

New figures show that prostate cancer accounts for a third of those not treated for cancer compared to before the pandemic. Prostate cancer is very treatable if caught early. Its important for men to know their risk because early prostate cancer often has no symptoms. Joe Appiah, from Bromley, was diagnosed with prostate cancer during the pandemic. He didnt have symptoms. Id seen adverts about prostate cancer, but I didnt know how badly black men were affected, or how to get a test. I didnt have symptoms and wasnt aware of any family history. So until my friend told me to speak to my GP, I didnt think about it especially with Covid too. My friend saved my life. Thanks to him it was caught just in time.

Please check your risk and share the thirty-second online risk checker with loved ones.

It takes 30 seconds to complete and could save lives.

Unnecessary Biopsies In Low Risk Men

The proportion of low risk men who underwent unnecessary biopsies was assessed by racial group. At a threshold of 10%, assuming that men with higher scores are biopsied, 250/487 low risk men would have undergone a biopsy with PCPT and 466 with PBCG. Almost all low risk Black men are biopsied with both PCPT and PBCG . For Whites and Others, the proportion of low risk men biopsied with PCPT is much lower relative to PBCG .

At the 30% threshold, PCPT would spare most low risk men a biopsy and only subject 5% to a prostate biopsy, while 42% are still biopsied with PBCG. In Blacks, the number of low risk men biopsied substantially decreases to 25 with PCPT, but continues to remain high with PBCG at 121 . There were no White and Other men biopsied with PCPT, while 27 and 38% were biopsied using PBCG, respectively. The increase in risk scores seen in PBCG does not spare low risk men, resulting in many unnecessary biopsies performed in men with indolent or no PCa.

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Speaking To Your Gp About Your Risk

Thank you for completing our online risk checker. If youve decided to speak to your GP about your risk of getting prostate cancer, the information on this page may be helpful.

Can I see a GP during the coronavirus pandemic?

Yes your GP surgery is open and its important to contact them if you’re worried about your risk of prostate cancer or have any unusual symptoms.

Many GP practices now allow patients to see their GP in person. But for others, you may still have a phone or video appointment first to discuss your concerns. Your GP may then ask you to book another appointment if they want to see you in person for example, if you decide to have a PSA blood test. Your GP surgery will have made changes to help prevent the spread of coronavirus call them if youre worried or want more information on this.

How Do I Find Out More

Prostate cancer in 5 minutes

Theres lots of information available on our website, including more information about:

You can also speak to our Specialist Nurses on 0800 074 8383, or by email, Live Chat, social media or SMS. They can talk to you, a partner or anyone else at risk of prostate cancer about the risk factors and the tests used to help diagnose prostate cancer.

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Symptoms Of Prostate Cancer

When this happens, you may notice things like:

  • an increased need to pee
  • straining while you pee
  • a feeling that your bladder has not fully emptied

These symptoms should not be ignored, but they do not mean you have prostate cancer.

It’s more likely they’re caused by something else, such as prostate enlargement.

Living With Prostate Cancer

As prostate cancer usually progresses very slowly, you can live for decades without symptoms or needing treatment.

Nevertheless, it can affect your life. As well as the possible side effects of treatment, a diagnosis of prostate cancer can understandably make you feel anxious or depressed.

You may find it beneficial to talk about the condition with your family, friends, a GP and other people with prostate cancer.

Financial support is also available if prostate cancer reduces your ability to work.

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Information About Calculator Input

Prostate Specific Antigen Level

This is the result, in nanograms per mililiter, of the PSA blood test. PSA has to be between 2 and 50 .

Family History of Prostate Cancer

Choose Yes if a father, brother, or son had prostate cancer.

Digital Rectal Examination

Digital Rectal Examination is a test performed by a health care professional in which a gloved finger is placed in the rectum to feel the surface of the prostate. It is normal if the prostate is smooth and soft. It is abnormal if an area of firmness or a nodule is noted.

Prior Prostate Biopsy

The Prostate Cancer Risk Calculators

Risk Calculator 1 the general health calculator is a starting point, looking at family history, age and any medical problems with urination.

Risk Calculator 2 the PSA risk calculator looks at the levels of prostate specific antigen in patients blood to help predict whether further investigation is required.

Risk calculator 3 and 4 the urologist risk calculator using data from DRE, TRUS and/or MRI and providing probabilities based on traditional Gleason grading or with inclusion of cribriform growth for the definition of clinically significant prostate cancer.

The option of calculating probabilities based on a definition of clinically significant prostate cancer including information on cribriform growth and intraductal carcinoma is currently available for the risk calculators without MRI information.

See table below for difference in definition of clinically significant prostate cancer

Indolent prostate cancer
Gleason score 3+3 Gleason 3+4 of higher or clinical stage > T2B
Cribriform risk calculator 3/4 GG1 or GG2 without cribriform growth or intraductal carcinoma GG2 with cribriform or intra ductal carcinoma or GG3 or higher

Nowadays these risk calculators are combined into one decision tree and thus can be used for men that have not been previously biopsied but also for men that have been screened previously and had a prostate biopsy with a benign result. In addition, if available, there is an option to include the result of an MRI .

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Study Population And Origin Of Data

Ideally, the development of risk stratification tools is based on data of a prospective longitudinal cohort study. Information on received diagnostic and staging examinations and treatment modalities should be readily available and indicates generalizability and usefulness of the model. The medical field is continuously evolving and patients recruited a long time ago may have undergone different treatments than recommended by current guidelines. For example, primary androgen deprivation therapy monotherapy for high-risk PCa is no longer considered as a contemporary treatment strategy and nowadays magnetic resonance imaging prior to biopsies is advised. In the Swedish database, the cohort was stratified by treatment and year of diagnosis to tackle this issue when calculating concordance indices .

The tools themselves, however, are developed in selected cohorts treated in different time frames. The DAmico risk groups are based on localized PCa patients who underwent definitive local therapy prior to 1998, thus without accounting for deferred treatment strategies such as active surveillance or watchful waiting . This points out the need for exhaustive external validation in different cohorts to confirm the generalizability of the predicted risks.

Prostate Cancer Patients Could Be Spared Needless Surgery Thanks To Nhs Risk Calculator

Many men risk side effects like impotence with invasive precautionary treatments while half of the 47,000 men diagnosed with prostate cancer are better left untreated

  • 0:27, 13 Mar 2019

THOUSANDS of men diagnosed with prostate cancer could be spared needless surgery thanks to a new NHS risk calculator.

The free online tool predicts whether tumours will become deadly over the course of 15 years with 84 per cent accuracy.

Current NHS tests are correct around 69 per cent of the time.

The one-minute check uses routinely available patient data such as age, cancer grade and levels of PSA protein.

Half of the 47,000 men diagnosed with prostate cancer annually are better left untreated. But many risk side effects including impotence and incontinence by choosing invasive procedures as a precautionary measure.

The online test can also measure the risk of such side effects, journal PLOS Medicine revealed.

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Diagnosis Of Prostate Cancer

A healthcare professional may suspect prostate disease if you have some or all of the following:

You may be given a referral to urology and require further testing, such as an MRI or prostate biopsy. Often, doctors wont order an MRI until after the biopsy, which is unfortunate since MRI could prevent an unnecessary negative biopsy.

Doctors use results from clinical tests to diagnose and stage prostate cancer. Staging assigns a value to the cancer which helps determine treatments and also helps provide context regarding prognosis.

One tool doctors use is the Gleason Score. After a prostate biopsy, a pathologist or cytotechnologist will look at the tissue under a microscope. They observe the biopsied cells for differences and similarities to normal cells. Cancer cells that look more like normal tissue get lower Gleason Scores.

Who Is At Risk For Prostate Cancer

Treating prostate cancer

All men are at risk for prostate cancer, but African-American men are more likely to get prostate cancer than other men.

All men are at risk for prostate cancer. Out of every 100 American men, about 13 will get prostate cancer during their lifetime, and about 2 to 3 men will die from prostate cancer.

The most common risk factor is age. The older a man is, the greater the chance of getting prostate cancer.

Some men are at increased risk for prostate cancer. You are at increased risk for getting or dying from prostate cancer if you are African-American or have a family history of prostate cancer.

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Psa And Prostate Screening Methods

Prostate cancer detection methods have traditionally comprised a digital rectal exam DRE and prostate-specific antigen PSA testing. Today, a magnetic resonance imaging scan with IV contrast may be able to detect and exclude high-risk prostate cancer as reliably.

Currently, the United States Preventive Services Task Force recommends that men aged 55 to 69 and their primary healthcare provider decide about screening for prostate cancer.

If youre having symptoms of prostate dysfunction, your healthcare provider may want you to do a blood test to measure your free PSA. This will tell them the amount of PSA currently circulating in your bloodstream.

The European Randomized Study of Screening for Prostate Cancer found a 21% reduction in prostate cancer mortality by measuring PSA levels.

But an elevated level doesnt always mean you have cancer. Other conditions such as benign prostatic hyperplasia can raise your PSA to as much as 2.5 times the normal value.

Some studies suggest that urinary tract infections, prostate stimulation, and inflammation may cause elevated PSA tests.

Prostate Cancer Prevention Trial Risk Calculator Version 20

Disclaimer

The original Prostate Cancer Prevention Trial Prostate Cancer Risk Calculator posted in 2006 was developed based upon 5519 men in the placebo group of the Prostate Cancer Prevention Trial. All of these 5519 men initially had a prostate-specific antigen value less than or equal to 3.0 ng/ml and were followed for seven years with annual PSA and digital rectal examination . If PSA exceeded 4.0 ng/ml or if an abnormal DRE was noted, a biopsy was recommended. After seven years, all men were recommended to have a prostate biopsy, regardless of PSA or DRE findings. PSA, family history, DRE findings, and history of a prior negative prostate biopsy provided independent predictive value to the calculation of risk of a biopsy that showed presence of cancer.

The results of the PCPTRC may not apply to different groups of individuals. As about 80% of men had a prostate biopsy with six cores, if more than six cores are obtained at biopsy, a greater risk of cancer may be expected. Most men in this study were white and results may be different with other ethnicities or races. The calculator is in principle only applicable to men under the following restrictions:

  • Age 55 or older
  • No previous diagnosis of prostate cancer
  • DRE and PSA results less than 1 year old

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Rotterdam Prostate Cancer Risk Calculator

The Rotterdam Prostate Cancer Risk Calculator app was released through the Prostate Cancer Research Foundation, Rotterdam, in partnership with the European Randomized Study of Screening for Prostate Cancer . The tool can be accessed as a smartphone or tablet app, available on Android or iOS , or via a series of calculators at .

The website version of the risk calculators are meant for use as a decision aid for laypeople, general practitioners and urologists2. On the website there are 6 calculators. These calculators provide an estimate of risk of sextant biopsy detectable prostate cancer based upon age, family history, and urinary complaints , PSA alone . Calculators 3-6 are designed for use by urologists and require more complex information such as DRE findings and volume, TRUS findings and volume and previous biopsy status.

The mobile application was developed to improve the user friendliness and accessibility of the calculators and combines a lot of the previous calculators into one easy to use application3. The values that the calculator uses include PSA, Previous biopsy negative, DRE examination findings, TRUS volume and TRUS findings and Phi . If the patient has not had a TRUS than volume can be estimated according to DRE findings instead.

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