Risk calculator aids in prostate cancer screening

For more than a decade, researchers have debated whether men should have prostate-specific antigen tests, known as PSA tests, to screen for prostate cancer. The controversy centers on the tests’ reliability for predicting whether a man has an aggressive cancer that requires treatment.

“An elevated result doesn’t necessarily mean you have cancer,” explained Joseph Presti, MD, an adjunct researcher at the Kaiser Permanente Northern California Division of Research and the leader of urologic oncology surgery in Northern California. “Even if you do, it might be a low-grade cancer that will never grow any larger or become a threat to your life.”

But in some cases, an elevated PSA can help identify aggressive cancers before they spread and become deadly.

A prostate cancer risk calculator developed by Kaiser Permanente researchers provides information that may help men being screened for prostate cancer make informed decisions about next steps. The calculator predicts a patient’s likelihood of having a biopsy that shows no cancer, a low-grade cancer, or a high-grade cancer following an elevated PSA test or abnormal rectal exam based on factors including age, race, family history of prostate cancer, body mass index, PSA level, and prostate size, among others.

Kaiser Permanente recently evaluated the accuracy of the risk calculator in a 21-month study of over 4,000 patients. The study, published in the journal Urologic Oncology, showed that the calculator provides useful information that can improve decision-making about the need for biopsy.

“The results can help the patient determine whether to undergo additional tests or have a biopsy,” said Dr. Presti. “Ideally, we would only perform biopsies on men with significant risk of having an aggressive cancer that needs treatment.”

Shared decision-making between men and their doctors

The calculator is the first to have been developed using a racially diverse population, and the information it provides reflects racial and ethnic disparities in prostate cancer incidence and death. Black men are more likely than men of other races and ethnicities to be diagnosed with prostate cancer and to die from the disease. They are also more likely to develop prostate cancer at a younger age. Taking this into account, the calculator provides personalized risk assessment for each patient.

“By leveraging our large patient database, we sought to create a better tool to help patients and providers determine the value of pursuing a diagnosis after an elevated PSA,” said Andrew L. Avins, MD, MPH, the study’s senior author and a research scientist at the Division of Research.

“As our study shows, this tool can help patients make more personally relevant decisions about whether to have a biopsy to look for prostate cancer,” said Dr. Avins. “Our goal is to help them make decisions that are in line with their preferences and values.”

Learn more about Kaiser Permanente’s cancer care at kp.org/cancercare.