Individualizing Prostate Cancer Risk Assessment
ORLANDO—Dutch researchers say they have devised a personalized risk calculator that may help determine a man's future risk of prostate cancer. The new tool also identifies men who may be candidates for heightened surveillance or active risk-reduction strategies.
Developed by investigators at Erasmus University Medical Center in Rotterdam, the tool combines PSA test results with additional prostate cancer factors, including previous prostate biopsy results, family history of prostate cancer, and prostate size.
“The idea of assessing a combination of baseline PSA levels and specific, known risk factors to give a longer-term view about prostate cancer risk is a pivotal concept that we hope will become part of standard practice,” said lead investigator Monique J. Roobol, PhD, an epidemiologist in urologic oncology.
“This approach is in line with the concept of personalized medicine, in which screening is based on an individual's unique risk profile.”
Dr. Roobol and her colleagues evaluated the risk of a prostate cancer diagnosis four years later in 5,176 men by examining the value of PSA combined with digital rectal examination findings, prostate volume (more or less than 44 cc), previous prostate biopsy results, family history of prostate cancer, and age.
For any given PSA level, a family history of prostate cancer increased a man's future cancer risk. Conversely, a previous negative biopsy and higher prostate volume was associated with a lower overall risk.
At a PSA level of 1.3 ng/mL, men with a negative previous biopsy, a positive family history of prostate cancer, and a prostate volume less than 40 cc had a 5% risk of a prostate cancer diagnosis in four years. A 5% four-year risk also was observed among men with a PSA level of 4.0 ng/mL but a previous negative biopsy, a negative family history, and a prostate volume greater than 40 cc.
Using a personalized risk calculator can enable a more accurate, longer-term view of a man's risk for prostate cancer, Dr. Roobol said. Arming patients and clinicians with this knowledge can help identify candidates who benefit significantly from more frequent screening, she said.
“This is the first study to look at future risk,” said Dr. Roobol, who presented findings at the 2009 Genitourinary Cancers Symposium. “This gives us an idea of what will happen in four years, and it can help determine whether a man needs to be seen again in a few months or not for four more years.”