Clinical decision models for diagnosis and follow-up in (oncological) urology
In 2009 the ERSPC study showed for the first time that screening for prostate cancer leads to a mortality reduction for men in the screening arm of the study as compared to men who received usual care (control group). Screening was, however, also associated with overdiagnosis and subsequent overtreatment. Including risk stratification in the screening algorithm may help reduce the overdiagnosis of low-risk, indolent prostate cancers.
The Rotterdam Prostate Cancer Risk Calculator was developed to inform and help both lay men and professionals. Lay men may use Risk Calculator 1 and 2, which will provide an advice on the likelihood of finding prostate cancer when men are examined further. Risk Calculators 3 to 6 are to be used by professionals; Risk Calculators 3 and 4 give an advice on whether or not a biopsy detectable prostate cancer is found, Risk Calculator 5 calculates the chance of having an indolent prostate cancer which may not require immediate treatment and Risk Calculator 6 calculates a man’s future risk over the next four years. The Rotterdam Prostate Cancer Risk Calculator has been externally validated, is available in an app (iOS and Android) and is included in national (General Practitioners guideline and Dutch Urological Association guideline) and international (European Association of Urology Guideline) Prostate Cancer Guidelines. Currently the Rotterdam Prostate Cancer Risk Calculator is being implemented in a primary health care setting.