Nomograms for prostate cancer risk assessment

Introduction

  • In men with a suspicious digital rectal examination (DRE) and/or elevated prostate specific antigen (PSA), prostate cancer (PCa) is typically confirmed by prostate biopsy. Prostate biopsy may cause pain, bleeding and infection. Therefore, it is important to determine pre-biopsy the risk that the biopsy will contain cancerous cells. (also see: Prostate cancer diagnosis)
  • PCa is not lethal in all men with the disease; most men will ultimately die from causes other than PCa. Therefore, decisions about treatment type and timing are frequently guided by an estimation of the risk that the tumour will ultimately progress (i.e. local progression (lymph nodes) or distant progression (e.g. back bone) and eventually death).(also see: Prostate cancer diagnosis)

Single clinical variables alone do not predict the outcomes of prostate biopsy or potential progression of the tumour. A combination of various clinical variables can give the best prediction of PCa diagnosis and progression in individual subjects.

Available risk calculators

CalculatorSeveral tools from different PCa research institutions have been developed to predict the risk of PCa on biopsy and its potential for progression. These are referred to as risk calculators and consist of predictive tables or nomograms. They are designed to help physicians and patients to decide whether biopsy is needed and, if PCa is confirmed on biopsy, which treatment approach would be most appropriate. They are based on the knowledge of and correct interpretation of clinical data of the individual patient. Therefore, it is strongly recommended to use the risk calculators in consultation with your physician.

A selection of well-known risk calculators, which are assessable through the Internet, is shown in Table 1. They differ in the type of population (US or European) studied and the type of clinical data which have to be known for calculating the risk, also in relation as to whether the individual men has

  • not (yet) had a biopsy (i.e. pre-biopsy in men with an abnormal DRE and/or elevated PSA)
  • not (yet) been treated (e.g. pre-operative in patients with a positive biopsy). 

 

Table 1: Some well-know risk calculators
Predictive tables Nomograms
  Cancer Risk Calculator for prostate cancer
Pre-biopsy, US
  Prostate Risk Indicator
Pre-biopsy, Europe
Partin Tables
Pre-operative, US
Center for Prostate Disease Research (CPDR)
Pre-operative, US
  Kattan or Memorial Sloan-Kettering Cancer Center (MSKCC)
Pre-operative, US
  Prostate Risk Indicator
Pre-operative, Europe

Most tools combine the following clinical data to predict the risk of PCa progression:

  • age (i.e. take into account life expectancy)
  • PSA level
  • stage (TNM: tumour, nodes, metastases)
  • Gleason score.

Some also add the number or percent of positive biopsy cores, the amount of cancer found in the biopsy and/or other information (e.g. radiation dose, hormone therapy use).

The Cancer Risk Calculator is currently the only risk calculator including PCA3 (Prostate CAncer gene 3). For more information see: http://deb.uthscsa.edu/URORiskCalc/Pages/calcs.jsp

Calculating your own risk of prostate cancer progression

Please indicate below which of the following applies to you and you will be guided to appropriate risk calculators.

Suspected PCa pre-biopsy (abnormal DRE/elevated PSA)

Confirmed PCa pre-operative (positive biopsy/pre-treatment)