Suspected PCa pre-biopsy

Pre-biopsy (abnormal DRE / elevated PSA)

1. Cancer Risk Calculator for prostate cancer

prostate biopsyA risk calculator is available for men with suspected PCa based on an abnormal DRE or elevated PSA. It predicts the probability of a positive biopsy, including the probability of a high grade (high Gleason score) biopsy. It takes into account

  • race
  • age
  • family history of PCa
  • DRE outcome
  • serum PSA
  • whether or not a prior biopsy was negative.

This risk calculator is based on the Prostate Cancer Prevention Trial (PCPT) [1]. In this study, 5519 older American men with a relatively low PSA ( ≤ 3 ng/mL) who did not receive active treatment for 7 years had a 6-core biopsy.

More information:

The risk calculator has very recently been updated and now also includes the PCA3 Score. For more information see

2. Prostate Risk Indicator

This risk calculator currently consists of 4 prostate risk indicators. The first 3 predict the probability of a positive biopsy. They take into account

Risk indicator 1

1.age history of PCa
3.frequency of urinary symptoms according to the International Prostate Symptom Score (I-PSS)

Risk indicator 2


Risk indicator 3

2.presence or absence of hypoechogenic lesions during transrectal ultrasonography (TRUS)
3.DRE outcome
4.prostate volume

The Prostate Risk Indicator is based on data from 6288 Dutch men aged 55-74 years living in Rotterdam and participating in the European Randomized Study of Screening for Prostate Cancer (ERSPC) [2]. These men were tested for serum PSA and for any prostate abnormalities by DRE and TRUS and were subsequently followed-up over time.

More information:

[1] Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or = 4.0 ng per milliliter. N Engl J Med 2004;350: 2239-46.

[2] Roobol MJ, Schröder FH, Kranse R, ERSPC, Rotterdam. A comparison of first and repeat (four years later) prostate cancer screening in a randomized cohort of symptomatic men aged 55-75 years using a biopsy indication of 3.0 ng/ml (results of ERSPC, Rotterdam). Prostate 2006;66:604-12.