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

The risk calculators developed for men who have had a positive biopsy but have not yet received active treatment (e.g. radical prostatectomy, radiation therapy or hormone therapy) intend to predict pre-operatively the pathological stage:

• is the tumour still confined to the prostate?
• has the tumour spread beyond the prostate into surrounding tissues such as the seminal vesicles?
• has the tumour spread to the lymph nodes or more distant organs?

The prediction of the pathologic stage is used to make a decision if watchful waiting may be appropriate or active treatment is advisable. The most well-known risk calculators to predict pathological stage pre-operatively are:

1. Partin Tables

The best-known risk calculator for predicting pathological stage is the Partin Tables. This risk calculator takes into account

• pre-treatment PSA
• biopsy Gleason score
• clinical stage.

It is based on data from 5000 patients who underwent radical prostatectomy by a single surgeon at Johns Hopkins in the US.

More information: http://urology.jhu.edu/prostate/partintables.php

2. Center for Prostate Disease Research Tables (CPDR)

Similar to the Partin Tables, the Center for Prostate Disease Research (CPDR) Tables predict pathological stage based on pre-operative clinical parameters:

• race
• pre-treatment PSA
• biopsy Gleason score
• clinical stage.

In contrast to the Partin tables, they are based on a more racial diverse US population who underwent surgery at multiple institutions.

More information: http://www.cpdr.org/programs/database/preop.html

3. Memorial Sloan-Kettering Cancer Center (MSKCC) or Kattan pre-treatment nomogram

Kattan, a biostatistician of the MSKCC in the US, has developed the Kattan pre-treatment nomogram to predict pre-operatively pathological stage based on

• pre-treatment PSA
• biopsy Gleason score
• clinical stage,
• age
• percentage of positive biopsy cores.

More information: http://www.mskcc.org/mskcc/applications/nomograms/PreTreatment.aspx

4. Prostate Risk Indicator

This risk calculator currently consists of 4 prostate risk indicators. Indicator 4 predicts for men with a positive biopsy, the likelihood of having indolent PCa. This takes into account

• Gleason score
• mm cancer in biopsy
• mm healthy tissue in biopsy
• prostate volume
• pre-treatment PSA

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) [1]. 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: http://www.prostate-riskindicator.com/via.html

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[1] 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.