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 to more distant organs?

To use these risk calculators, the following clinical data should be available:

• clinical stage (based on examination of biopsy tissue)
• Gleason score in biopsy
• pre-treatment PSA.

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:

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1. Partin Tables

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

1. pre-treatment PSA
2. biopsy Gleason score
3. 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

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2. Center for Prostate Disease Research Tables (CPDR)

Similar to the Partin Tables, the CPDR Tables predict pathological stage based on pre-operative clinical parameters:

1. race
2. pre-treatment PSA
3. biopsy Gleason score
4. 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

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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

1. pre-treatment PSA
2. biopsy Gleason score
3. clinical stage
4. age
5. percentage of positive biopsy cores.

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

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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 or non-significant PCa. This takes into account

1. Gleason score
2. mm cancer in biopsy
3. mm healthy tissue in biopsy
4. prostate volume
5. pre-treatment PSA

Please note that you need to consult a physician to use indicator 4.

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). These men were tested for PSA in their blood 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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