Individualized Risk Assessment of Prostate Cancer

Disclaimer

The original Prostate Cancer Prevention Trial (PCPT) Prostate Cancer Risk Calculator (PCPTRC) 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 (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.

In 2012, the updated PCPTRC 2.0 was released with the added capability to provide prediction of low-grade (Gleason grade < 7) versus high-grade prostate cancer via a new more user-friendly display of results. PCPTRC 2.0 was based on re-analysis of an expanded set of 6664 biopsies from 5826 patients from the PCPT placebo arm. Characteristics of the patients and biopsies forming PCPTRC 2.0 are similar to those used for the original PCPTRC, but the new PCPTRC 2.0 generally provides lower risk estimates due to the inclusion of multiple prior negative biopsies per individual rather than just one biopsy per person. The original PCPTRC is still available for research purposes on the right hand side of the calculator page, along with prior updates for incorporating other markers for prostate 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 PCPT 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.

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


  

Reference: Thompson IM, Ankerst DP, Chi C, Goodman PJ, Tangen CM, Lucia MS, Feng Z, Parnes HL, Coltman CA Jr. Assessing prostate cancer risk: Results from the Prostate Cancer Prevention Trial, Journal of the National Cancer Institute 98: 529-534, 2006.
Date Last Modified: March 19, 2014

The University of Texas Health Science Center at San Antonio

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