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Rotterdam Prostate Cancer Risk Calculator

What Information Does The Calculator Provide

Prostate Cancer: What’s Your Risk?

The calculator provides the detectable prostate cancer risk as a percentage. The risk is given as a score for detectable prostate cancer and for significant prostate cancer. Significant prostate cancer is defined as tumour stage greater than T2b, and/or having a Gleason biopsy score of equal to or greater than 7. The percentage risk of prostate cancer leads to the following recommended actions:

  • < 12.5% no prostate biopsy
  • 12.5% 20% consider prostate biopsy depending on co-morbidity and more than average risk of high grade prostate cancer
  • 20% or more prostate biopsy recommended

Should you ever forget this information it is easily accessed within the app, by touching the encircled question mark, under the percentage risks.

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.

Improving On The Rotterdam Prostate Cancer Risk Calculator By Ivo Dukic

Following the PROMIS trial , many cancer centres in the UK are now offering pre-biopsy multiparametric MRI for men suitable for radical treatment. The European Association of Urology for Prostate Cancer guidelines recommend individual risk stratification before the performance of mpMRI in men who have received a negative biopsy result .

The Rotterdam Prostate Cancer Risk Calculators are well validated models which help avoid 20-33% of unnecessary transrectal ultrasound guided biopsy of prostate . The calculators have been updated to include Prostate Imaging Reporting and Data System score and age, in both biopsy-naïve men and in patients who received previous TRUS-Bx.

The updated calculators can be found in an updated version of the Rotterdam Prostate Cancer Risk Calculator app. The app can be accessed as a smartphone or tablet app, available on Android or iOS or as a series of separate calculators at:

The updated app now uses the following parameters for the prediction of prostate cancer:

  • MRI
  • Prostate specific antigen
  • Previous negative biopsy
  • Digital rectal examination
  • TRUS volume
  • PIRADS version 1 score, 3-T MRI scanner.

What information does the app provide?

  • < 12.5% no prostate biopsy
  • 12.5-20% consider prostate biopsy depending on co-morbidity and more than average risk of high-grade prostate cancer
  • 20% or more prostate biopsy recommended.

How does this improve on the previous prostate cancer risk app?

References

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Epocrates Reference Tools For Healthcare Providers

“The most useful app I’ve found for day-to-day use with patients is the drug compendium Epocrates. Replacing the time-honored but heavy and cumbersome PDR, this app for smartphones contains information about drug use, dosing, sound alike medications, a list of contraindications and adverse reactions, alternatives, pharmacology, cost, and even a pictorial representation to identify many of those bags of pills patients bring to the office. Like many of the better software programs, it lists drug interactions to keep the prescriber out of trouble, notifications, and a search engine for treatment guidelines. We’d all like to think we have all this information embedded in our own gray matter but a little assist from a handy pocket app provides safety, efficiency, and increases value. The free app is sufficient for your purposes.”

Jeffrey E. Kaufman, MD

Private practice, Santa Ana, CA

Does This Apply To My Patients

Rotterdam Prostate Cancer Risk

The data for the RPCRC was gathered from the Dutch section of the ERSPC, and are based on a population aged 55-74 yr. The analyses are based on the biopsy outcomes of 3616 men screened for the first time, 24.5% of whom had prostate cancer detected. A further cohort of 2896 men was used to compile data on those men who had previously been screened, 34.1% of these men already had negative biopsies at first screening. Although the risk calculator has yet to be validated in a UK population it has been validated in a small contemporary clinical cohort despite significant differences between the screening group and the clinical cohort 4.

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Prostate Cancer Research Foundation Rotterdam

The Prostate Cancer Research Foundation Stichting Wetenschappelijk Onderzoek Prostaatkanker is an initiative of the Department of Urology of the Erasmus MC, the University and Medical Centre of Rotterdam, in The Netherlands. The goal of the Foundation is the financial support of scientific research projects in the field of prostate cancer specifically, and other cancers of the urinary tract in general.

Erasmus MC is one of eight European centres taking part in the worlds largest study of screening for prostate cancer, the European Randomized Study of Screening for Prostate Cancer,. The ERSPC was co-founded by Prof. Dr. F.H. Schröder, now emeritus professor at Erasmus and he is also co-founder of the Foundation. Under his leadership, the ERSPC continues to explore and determine the value of early detection of prostate cancer.

The board of the Foundation consists of:Prof. dr. M.J. Roobol-Bouts, chairmanDhr. mr. E.W. Groenveld, treasurerDr. L.D.F. Venderbos, secretary

Do Prostate Cancer Risk Models Improve The Predictive Accuracy Of Psa Screening A Meta

  • K.S. LouieCorrespondenceCorrespondence to: Dr Karly S. Louie, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK. Tel: +44-20-7882-3528AffiliationsCentre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  • A. SeigneurinAffiliationsCentre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UKJoseph Fourier UniversityGrenoble 1, CNRS, TIMC-IMAG UMR 5525, GrenobleMedical Evaluation Unit, Grenoble University Hospital, Grenoble, France
  • P. CathcartAffiliationsDepartment of Urology, University College Hospital London and St Bartholomew’s Hospital London and Centre for Experimental Cancer Medicine, Bart’s Cancer Institute, LondonThe Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
  • P. SasieniAffiliationsCentre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK

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Prostate Cancer Risk Calculator Apps In A Taiwanese Population Cohort: Validation Study

Chen, I-HA Chu, C-H Lin, J-T Tsai, J-Y Yu, C-C Sridhar, AN Sooriakumaran, P … Chand, M + view allChen, I-HA Chu, C-H Lin, J-T Tsai, J-Y Yu, C-C Sridhar, AN Sooriakumaran, P Loureiro, RCV Chand, M – view fewer Prostate Cancer Risk Calculator Apps in a Taiwanese Population Cohort: Validation Study.Journal of Medical Internet Research, 22 , Article e16322. 10.2196/16322. .

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A Calculator For Prostate Cancer Risk 4 Years After An Initially Negative Screen: Findings From Erspc Rotterdam Beyond The Abstract By Xiaoye Zhu Md And Monique J Roobol Phd Msc

Genetic Risk Score for Prostate Cancer Screening

BERKELEY, CA – PSA screening reduces prostate cancer mortality. Therefore, general practitioners and urologists are increasingly confronted with requests for PSA testing.However, there are several substantial harms as a result of screening, such as unnecessary biopsies and over-diagnosis. Furthermore, there is uncertainty surrounding the follow-up of men who were screened negatively for prostate cancer. When the screening test or the prostate biopsy is negative, physicians often struggle with questions regarding if and how to continue testing.

To provide support in these difficult decision points, we have developed the future-risk calculator, based on data from 15 791 screen-negative men at the initial screening round from the Rotterdam branch of the ERPSC trial. This calculator is readily available on our website: www.prostatecancer-riskcalculator.com. It was based on initial screening data on age, PSA, digital rectal examination, family history, prostate volume, and information on previous biopsy. The outcome was the 4-year risk of biopsy-detectable prostate cancer, which was a priori categorized as no cancer, cancer with a low risk of progression, and cancer with a potentially high risk of progression. The 4-year predictions were validated with additional follow-up data up to 8 years after initial screening.

Figure 1A: 4-year future risk of a 65-year-old man, PSA 2.5 ng/ml, normal DRE, no family history, prostate volume class of 40 cm3, and no previous biopsy.

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Number Of Avoided Biopsies And Missed Clinically Significant Prostate Cancer

Figure presents the theoretical number of biopsies avoided and missed csPCa at the 10% and30% risk thresholds.

Fig. 2

Theoretical number of avoided biopsies and missed clinically significant cancers at the 10 and 30% predictive thresholds by race. PCPT=Prostate Cancer Prevention Trial risk calculator PBCG=Prostate Biopsy Collaborative Group risk calculator csPCa=clinically significant prostate cancer. Blue bar: Total number of biopsies avoided Red bar: Missed clinically significant prostate cancer

At the 10% threshold, assuming no biopsies are performed below this threshold, the number of biopsies avoided with the PCPT RC for All men is 336/954 compared to 28/954 with PBCG. The PCPT RC, however, missed 80 csPCas compared to 4 csPCas when using PBCG. Few Black men fall below the 10% risk threshold, so the number of avoided biopsies is small with both calculators. The difference is particularly prominent in Whites where the percentage of biopsies avoided is ten-fold higher with PCPT relative to PBCG .

At the 30% threshold in All men, 748 biopsies are avoided using PCPT compared to 376 with PBCG, and the number of missed csPCa is 207 and 85 , respectively. Black and Other men demonstrate a similar trend, where more than twice as many biopsies are avoided using PCPT with similar rates of missed csPCa .

Outcome Measurements And Statistical Analysis

We measured the detection rate for high-grade PCa for TBx and SBx. We carried out a retrospective stratification according to RPCRC biopsy advice to determine the rate of mpMRI and biopsies that could potentially be avoided by RPCRC-based patient selection in relation to the rate of high-grade PCa missed.

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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

Design Setting And Participants

Rotterdam Prostate Cancer Risk

The RC3 is based on the first screening round of the ERSPC Rotterdam, which involved 3616 men. In 2015, histopathologic slides for PCa cases were re-evaluated. Low-risk PCa was defined as ISUP grade 1 or 2 without CR/IDC. High-risk PCa was defined as ISUP grade 2 with CR/IDC and PCa with ISUP grade3.

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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.

Gucs 200: Personalized Calculator For Future Risk For Prostate Cancer

Nick Mulcahy

February 26, 2009 A personalized risk calculator a tool that combines 4 prostate cancer risk factors, 1 of which is prostate-specific antigen more accurately predicts a man’s future risk for prostate cancer than PSA alone.

A study of the risk calculator was highlighted at a press conference at the 2009 Genitourinary Cancers Symposium, which is cosponsored by the American Society for Clinical Oncology, the American Society for Radiation Oncology, and the Society of Urologic Oncology.

“PSA is used to evaluate a man’s current risk of prostate cancer. But what about future risk?,” asked the study’s lead author Monique Roobol, PhD, an epidemiologist in urologic oncology at Erasmus University Medical Center, in Rotterdam, the Netherlands.

To assess a man’s future risk, the calculator uses PSA results along with 3 other common factors that predict prostate cancer risk: previous prostate biopsy results, family history of prostate cancer, and prostate size.

The investigators found that an increasing PSA was the strongest single predictor of prostate cancer risk, but that the other risk factors also “significantly altered prostate cancer risk.”

They found that, for any given PSA level, a family history elevated an individual’s future risk, whereas a previous negative biopsy and increasing prostate volume lowered risk.

For men above a certain risk threshold, more frequent screening and the use of active risk reduction strategies is warranted, said Dr. Roobol

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Comparison Of Risk Calculator Models

The predictive accuracy was quantified using the area under the curve for the receiver operator characteristic analysis . A multivariable meta-analysis was performed to pool the AUCs in predicting any PCa and csPCa. Within-study correlations of the AUCs were estimated using bootstrapping. To analyze statistically significant differences in the models and taking into account the between-study heterogeneity we subsequently estimated the probability that a model has the highest AUC in a subsequent validation study. We simulated 10,000 samples from the posterior distribution to estimate this probability . Calibration of the RCs was pooled and explored graphically using calibrations plots. For comparison, the per center sensitivity and specificity of detecting csPCa with applying a PSA cut-off 4.0 ng/mL was calculated and graphically displayed.

Prostate Cancer Risk Calculator Offers Men Individual Risk Assessment

Using the polygenic risk score for targeted prostate cancer screening

18 May 2012

Men worried about prostate cancer have a new online resource, freely available, to help them assess their risk. The multi-step Prostate Cancer Risk Calculator, launched yesterday, 17 May 2012, has been created by the founders of the European Randomized Study of Screening for Prostate Cancer .

Prostate Cancer Risk Calculator is easy and simple for people to use. Men can use the first two calculators to assess their individual risk of developing prostate cancer without needing any medical expertise. The first starts with family history and general health information. The second is for use if you also have the results of a simple blood test to assess the level of prostate specific antigen . Prostate cancer is one of the most common cancers in men but recent improvements in treatment and diagnosis mean that more men will survive the disease.The online resource provides a range of helpful information about the disease. This includes the benefits and disadvantages of going for a PSA test when you do not have symptoms. PSA levels tend to increase as men age and can be a sign of prostate disease, though not always cancer.

Specialist clinical risk assessment tools

*The Prostate Cancer Risk Calculator is the property of the Prostate Cancer Research Foundation, Rotterdam . For details on board members please refer here.

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Rotterdam Prostate Cancer Risk Calculator App

The widespread use of prostate specific antigen testing has led to diagnostic difficulties for patients and urologists. The sensitivity and specificity characteristics of PSA are far from optimal. To try and improve the predictive accuracy of PSA measurements, nomograms and artificial neural networks have been created by many groups across the world1. By combining PSA measurements with various examination and investigation findings these predictive models have shown to be superior to PSA alone1. Initially these models were available as paper-based nomograms or as calculators via the internet but now this form of prediction can be produced on any smartphone or tablet via an app.

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