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The Prostate Cancer Risk Calculators

Risk Calculator 1 – the general health calculator is a starting point, looking at family history, age and any medical problems with urination.

Risk Calculator 2 – the PSA risk calculator looks at the levels of prostate specific antigen (PSA) in patient’s blood to help predict whether further investigation is required.

Risk calculator 3 and 4 – the urologist risk calculator using data from DRE, TRUS and/or MRI and providing probabilities based on traditional Gleason grading or with inclusion of cribriform growth for the definition of clinically significant prostate cancer.

The option of calculating probabilities based on a definition of clinically significant prostate cancer including information on cribriform growth and intraductal carcinoma is currently available for the risk calculators without MRI information.

See table below for difference in definition of clinically significant prostate cancer

Indolent prostate cancer Clinically significant prostate cancer
Original Risk calculator 3/4 Gleason score 3+3 (GG1) Gleason 3+4 of higher ( >= GG2 ) or clinical stage > T2B
Cribriform risk calculator 3/4 GG1 or GG2 without cribriform growth or intraductal carcinoma GG2 with cribriform or intra ductal carcinoma or GG3 or higher

Nowadays these risk calculators are combined into one decision tree and thus can be used for men that have not been previously biopsied but also for men that have been screened previously and had a prostate biopsy with a benign result. In addition, if available, there is an option to include the result of an MRI (the PIRADS score).

There are two ways to include information on prostate volume, i.e. using data on prostate volume obtained during TRUS or MRI, or using a DRE based prostate volume estimate which can be entered as 25, 40 or 60 cc.

Inclusion of prostate volume in the risk calculation gives a more accurate estimation of the risk of having a biopsy detectable (potentially aggressive) prostate cancer.

Available data can be entered step by step and on the basis of what is being entered the risk of having a biopsy detectable (clinically significant) prostate cancer is displayed.

Risk calculator 3 and 4 – the urologist risk calculator using data from DRE, TRUS and the result of a Phi test: Using this risk calculator gives you the possibility to include the outcome of the so-called Prostate Health Index (Phi) blood test which will slightly increase predictive capability. Please note that outcome is based on traditional Gleason grading only, cribriform growth pattern is not used, and also information in MRI cannot be included.

Risk calculator 5 calculates the chance of having indolent prostate cancer which may not require immediate treatment.

Risk Calculator 6 is the latest in the series — it calculates a man’s future risk over the next four years, taking into account age, prostate-specific antigen, digital rectal examination, family history, prostate volume, and previous biopsy status.

Contact Information

Monique Roobol
Risk Calculator Administrator

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Tell us what you think about the risk calculators and what your experience has been.

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Please note when interpreting calculated risks

Our risk calculators 3 and 4, including the information on MRI, have now been calibrated on a contemporary setting with a positive predictive value (PPV) of 40% for overall prostate cancer detection (i.e. 40% of men biopsied have prostate cancer) and a PPV of 20% for prostate cancer with Gleason 7 or higher.

Similar numbers for men having had a previous negative biopsy are 30% for overall prostate cancer detection and 20% for Gleason >= 7 prostate cancer.
If, in your hospital setting these PPV’s are significantly different, please contact SWOP, we can provide calibration adjustments.