Risk-Calculator Articles


  • A calculator for prostate cancer risk 4 years after an initially negative screen: Findings from ERSPC Rotterdam, "Beyond the Abstract," by Xiaoye Zhu, MD and Monique J. Roobol, PhD, MSc

    BERKELEY, CA (UroToday.com) - PSA screening reduces prostate cancer mortality.[1, 2] Therefore, general practitioners and urologists are increasingly confronted with requests for PSA testing.

    Published January 24, 2013
  • A comparative effectiveness analysis of the PBCG vs. PCPT risks calculators in a multi-ethnic cohort.

    Predictive models that take race into account like the Prostate Cancer Prevention Trial Risk Calculator 2.0 (PCPT RC) and the new Prostate Biopsy Collaborative Group (PBCG) RC have been developed to equitably mitigate the overdiagnosis of prostate specific antigen (PSA) screening.

    Published December 3, 2019
  • A Risk Calculator Predicting Recurrence in Lymph Node Metastatic Penile Cancer.

    To date, no validated prognostic tool is available in patients with penile squamous cell carcinoma (pSCC) and inguinal lymph node metastases (ILNM). We aimed to develop and externally validate a risk calculator for prediction of any cancer recurrence in ILNM pSCC patients.

    Published July 20, 2020
  • Changing the Prostate Cancer Detection Paradigm: Clinical Application of European Association of Urology Guideline-recommended Magnetic Resonance Imaging-based Risk Stratification in Men with Suspected Prostate Cancer.

    Multiparametric magnetic resonance imaging using the Prostate Imaging Reporting and Data System version 2.1 allows for a personalized, risk-stratified approach to indicating prostate biopsies (PBx) in order to reduce PBx and concomitant complications in men with suspected prostate cancer (PCa).

    Published October 14, 2020
  • Clinically significant Prostate Cancer diagnosed using a urinary molecular biomarker-based risk score: two case reports.

    Identifying men for a repeat prostate biopsy is a conundrum to urologists. Risk calculators (RCs) such as the European Randomized Study of Screening for Prostate Cancer (ERSPC) RCs have been developed to predict the outcome of prostate biopsies and have been shown to improve diagnostic accuracy compared to PSA alone.

    Published December 3, 2019
  • Expanding Active Surveillance Inclusion Criteria: A Novel Nomogram Including Preoperative Clinical Parameters and Magnetic Resonance Imaging Findings.

    Current European Association of Urology, American Urological Association, and National Comprehensive Cancer Network guidelines recommend active surveillance (AS) for selected intermediate-risk prostate cancer (PCa) patients.

    Published September 9, 2020
  • External Validation and Comparison of Prostate Cancer Risk Calculators Incorporating Multiparametric Magnetic Resonance Imaging for Prediction of Clinically Significant Prostate Cancer.

    To externally validate recently published prostate cancer risk calculators (PCa-RCs) incorporating multiparametric magnetic resonance imaging (mpMRI) for the prediction of clinically significant prostate cancer (csPCa) and compare their performance to mpMRI-naïve PCa-RCs.

    Published October 30, 2019
  • Improving the Rotterdam European Randomized Study of Screening for Prostate Cancer Risk Calculator for Initial Prostate Biopsy by Incorporating the 2014 International Society of Urological Pathology Gleason Grading and Cribriform growth.

    The survival rate for men with International Society of Urological Pathology (ISUP) grade 2 prostate cancer (PCa) without invasive cribriform (CR) and intraductal carcinoma (IDC) is similar to that for ISUP grade 1.
    Published July 25, 2017
  • Improving the Rotterdam European Randomized Study of Screening for Prostate Cancer Risk Calculator for Initial Prostate Biopsy by Incorporating the 2014 ISUP Gleason Grading and Cribriform growth: Beyond the Abstract

    Population-wide screening with PSA reduces the mortality of prostate cancer (PCa) but with the downside of overdiagnosis and overtreatment [1, 2]. Men considering a PSA test would like to be informed about their benefits, possibilities and extent of overdiagnosis and overtreatment [3]. However, candidates for testing are only willing to accept a small increase of their chance of dying from PCa when considering reducing their chance on overdiagnosis and potential overtreatment [4]. Multivariable risk-based stratification for screening, as put forward by the European Randomized Study of Screening for Prostate Cancer section Rotterdam Risk Calculator (ERSPC-RC), has the potential for informed decision making [5]. But, as stated by Pruthi et al., risk assessment tools do have some shortcomings, which reinforces the need for continuous updating and adaptations of the devices [6]. Within the current study we aimed to improve our ERSPC-RC by incorporating contemporary pathologic biopsy classifications that better reflect disease burden [7].

    Especially the course of disease of Gleason score 7 prostate cancer is heterogeneous. Kweldam et al.  found that the presence of a cribriform pattern (CR) and intraductal carcinoma (IDC) in Gleason 7 radical prostatectomy specimen are major predictive factors for the occurrence of distant metastases and also are related to prostate cancer-specific death [8]. This observation was confirmed when looking at this growth patterns in biopsy specimen. There it was shown that men with Gleason 7 on biopsy without the presence of CR and IDC had similar 15-year biochemical recurrence-free survival rates as compared with low-risk prostate cancer patients (Gleason 6) [9]. More accurate disease classification based on biopsy specimen is indispensable for treatment decision making. 

    We therefore decided to update the ERSPC-RC with these new insights. While improvement in risk prediction is mostly sought by adding new potentially relevant predictors to the model, we attempted to refine our predictions by including the in 2014 updated International Society of Urological Pathology Gleason Grading (ISUP) system and info on CR/IDC presence into the original calculator ERSPC-RC3. By doing so, we aim to better distinguish (lethal) clinically relevant PCa from indolent PCa (Figure 1). 

    Screen Shot 2017 07 25 at 1.28.25 PM
    Figure 1.
     The original risk calculator in comparison with the improved ERSPC-Cribriform-RC including cribriform pathological findings. The improved RC distinguishes better clinically relevant PCa and reduces the number of missed diagnosis of clinical relevant. PSA: Prostate Specific Antigen, DRE: Digital Rectal Exam, PV: Prostate Volume measured by DRE, ISUP: International Society of Urological Pathology. 

    The ERSPC-Cribriform-RC is a practical and easy-to-use risk calculator (Figure 2). The urologist only has to know the patient’s age, PSA result and findings of the digital rectal examination (DRE). DRE provides information whenever a node is present and gives an estimate of prostate volume, which is sufficient to be of aid in better predicting biopsy outcome. 

    Screen Shot 2017 07 25 at 1.28.54 PM
    Figure 2. Prostate cancer risk calculators can be found at www.prostatecancer-riskcalculator.com or as an app for your smartphone at the Appstore “Prostate cancer risk calculators”. There you can fill in the patient’s information. The risk calculator will provide for the probability of having clinical significant PCa and advice about biopsy.

    With the use of the ERSPC-Cribriform-RC, the urologist can substantially reduce the number of patients undergoing biopsy and at the same time minimize overdiagnosis. The current study shows that the use of the improved ERSPC-Cribriform-RC diminishes overdiagnosis with 34% while the percentage of missed diagnosis of clinically relevant PCa is 2%, which is a considerable improvement as compared to the original ERSPC-RC. Since this RC requires relatively easy retrieving information, general practitioners should also be able to use this tool and as such reduce the number of referrals. 

    To answer the patient’s question if he has a life-threatening PCa or not, just a simple PSA test is not enough. Combining relevant clinical characteristics and new pathological insights increases predictive ability. Most likely new developments like magnetic resonance imaging techniques, proteomics and/or genomics will provide more relevant pre-biopsy information that needs to be incorporated in future prediction tools. 

    Written by: Jan FM Verbeek, MD, Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands 

    Read the Abstract


    [1] Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. The Lancet. 2014;384:2027-35.
    [2] Loeb S, Bjurlin MA, Nicholson J, et al. Overdiagnosis and overtreatment of prostate cancer. European urology. 2014;65:1046-55.
    [3] Moynihan R, Nickel B, Hersch J, et al. Public opinions about overdiagnosis: A national community survey. PLoS One. 2015;10:e0125165.
    [4] Howard K, Salkeld GP, Patel MI, Mann GJ, Pignone MP. Men's preferences and trade-offs for prostate cancer screening: a discrete choice experiment. Health Expect. 2015;18:3123-35.
    [5] Roobol MJ, Verbeek JF, van der Kwast T, Kümmerlin IP, Kweldam CF, van Leenders GJ. Improving the ERSPC risk calculator for initial prostate biopsy incorporating the 2014 International Society of Urological Pathology Gleason grading and cribriform growth. European urology. 2017.
    [6] Pruthi DK, Ankerst DP, Liss MA. Novel definitions of low-risk and high-risk prostate cancer: Implications for the European Randomized Study of Screening for Prostate Cancer Risk Assessment Tool. European urology. 2017.
    [7] Kweldam CF, Kümmerlin IP, Nieboer D, et al. Prostate cancer outcomes of men with biopsy Gleason score 6 and 7 without cribriform or intraductal carcinoma. European ournal of cancer. 2016;66:26-33
    [8] Kweldam CF, Wildhagen MF, Steyerberg EW, Bangma CH, van der Kwast TH, van Leenders GJ. Cribriform growth is highly predictive for postoperative metastasis and disease-specific death in Gleason score 7 prostate cancer. Modern pathology. 2015;28:457-64.
    [9] Kweldam CF, Kümmerlin IP, Nieboer D, et al. Disease-specific survival of patients with invasive cribriform and intraductal prostate cancer at diagnostic biopsy. Modern pathology. 2016;29:630-6.
    Published July 25, 2017
  • Personalizing prostate cancer diagnosis with multivariate risk prediction tools: how should prostate MRI be incorporated?

    Risk-based patient selection for systematic biopsy in prostate cancer diagnosis has been adopted in daily clinical practice, either by clinical judgment and PSA testing, or using multivariate risk prediction tools.

    Published August 12, 2019
  • Predicting complications following radical cystectomy with the ACS NSQIP universal surgical risk calculator.

    Radical cystectomy (RC) is a challenging procedure with significant morbidity, though remains the standard of care treatment for many patients with bladder cancer. There has been debate regarding the utility of universal risk calculators to aid in point-of-care prediction of complications in individual patients preoperatively.

    Published August 29, 2019
  • Predicting the pathologic complete response after neoadjuvant pembrolizumab in muscle-invasive bladder cancer.

    In the PURE-01 study (NCT02736266), we aimed to evaluate the ability to predict the pathologic complete response (pT0N0) after pembrolizumab by using clinical and tumor biomarkers.

    In an open-label, single-arm, phase 2 study, 3 courses of 200 mg pembrolizumab preceding radical cystectomy (RC) were administered in patients with T2-4aN0M0 muscle-invasive bladder cancer (MIBC).

    Published June 15, 2020
  • Prediction of High-grade Prostate Cancer Following Multiparametric Magnetic Resonance Imaging: Improving the Rotterdam European Randomized Study of Screening for Prostate Cancer Risk Calculators.

    The Rotterdam European Randomized Study of Screening for Prostate Cancer risk calculators (ERSPC-RCs) help to avoid unnecessary transrectal ultrasound-guided systematic biopsies (TRUS-Bx). Multivariable risk stratification could also avoid unnecessary biopsies following multiparametric magnetic resonance imaging (mpMRI).

    Published August 13, 2018
  • Real-time individual predictions of prostate cancer recurrence using joint models, "Beyond the Abstract," by Jeremy M. G. Taylor, PhD

    BERKELEY, CA (UroToday.com) - This paper describes the methodology and results associated with a new online calculator for predicting prostate cancer recurrence.

    Published August 7, 2013
  • Validating the European randomised study for screening of prostate cancer (ERSPC) risk calculator in a contemporary South African cohort.

    Numerous prostate cancer predictive tools have been developed to help with decision-making in men needing prostate biopsy. However, they have been modelled and validated almost exclusively in Caucasian cohorts, hence limiting their use in other population groups.

    Published September 17, 2019