The Prostate Cancer Prevention Trial Prostate Cancer Risk Calculator (PCPTRC) 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 (PSA) value less than or equal to 3.0 ng/ml and were followed for seven years with annual PSA and digital rectal examination (DRE). 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

The PCPTRC is applicable for men who are undergoing prostate cancer screening with PSA and DRE as it was derived from a group of men in the Prostate Cancer Prevention Trial who underwent annual PSA and DRE screening. The risk estimate from the calculator does not reflect an endorsement of either PSA or DRE for screening for prostate cancer.

This calculator is designed to provide a preliminary assessment of risk of prostate cancer if a prostate biopsy is performed. Additional clinical information may modify this risk. No specific level of risk is recommended for prostate biopsy and this decision should be an individual choice based upon a physician-patient relationship.

The original PCPTRC was developed and validated using six pieces of information: PSA, age, DRE, race/ethnicity, any history of a prior prostate biopsy, and family history of prostate cancer. It was subsequently also extended in the Prostate Cancer Prevention Trial to include whether the individual is taking finasteride.

Subsequent to this, additional tests have been found to modify levels of risk of prostate cancer in individual men. For example, body mass index (a measure of obesity), has been found to be related to risk as have a number of prostate cancer blood or urine tests including percent free PSA, proPSA, and PCA3. Although these tests were not performed in the original Prostate Cancer Prevention Trial population of men, these tests have been demonstrated to improve, in some men, the diagnosis of PSA and the other risk factors.

As a result, the PCPTRC has been enhanced to include a number of the test results. A physician must request these tests and would be best informed as to which patients could benefit from these additional tests. The updated Calculator is provided to assist physicians and their patients with the interpretation of these results and the inclusion of these additional test results along with the other information used for the original PCPTRC.

For concerns or questions concerning the PCPTRC please email ankerst@uthscsa.edu