title: A Calculator for Prostate Cancer Risk 4 Years After an Initially Negative Screen: Findings from ERSPC Rotterdam.
abstract: BACKGROUND
  Inconclusive test results often occur after prostate-specific antigen (PSA)-based screening for prostate cancer (PCa), leading to uncertainty on whether, how, and when to repeat testing.
  
  
  OBJECTIVE
  To develop and validate a prediction tool for the risk of PCa 4 yr after an initially negative screen.
  
  
  METHODS
  We analyzed data from 15 791 screen-negative men aged 55-70 yr at the initial screening round of the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer.
  
  
  METHODS
  Follow-up and repeat screening at 4 yr showed either no PCa, low-risk PCa, or potentially high-risk PCa (defined as clinical stage >T2b and/or biopsy Gleason score ≥ 7 and/or PSA ≥ 10.0 ng/ml). A multinomial logistic regression analysis included initial screening data on age, PSA, digital rectal examination (DRE), family history, prostate volume, and having had a previous negative biopsy. The 4-yr risk predictions were validated with additional follow-up data up to 8 yr after initial screening.
  
  
  CONCLUSIONS
  Positive family history and, especially, PSA level predicted PCa, whereas a previous negative biopsy or a large prostate volume reduced the likelihood of future PCa. The risk of having PCa 4 yr after an initially negative screen was 3.6% (interquartile range: 1.0-4.7%). Additional 8-yr follow-up data confirmed these predictions. Although data were based on sextant biopsies and a strict protocol-based biopsy indication, we suggest that men with a low predicted 4-yr risk (eg, ≤ 1.0%) could be rescreened at longer intervals or not at all, depending on competing risks, while men with an elevated 4-yr risk (eg, ≥ 5%) might benefit from immediate retesting. These findings need to be validated externally.
  
  
  CONCLUSIONS
  This 4-yr future risk calculator, based on age, PSA, DRE, family history, prostate volume, and previous biopsy status, may be a promising tool for reducing uncertainty, unnecessary testing, and overdiagnosis of PCa.
authors: Department of Urology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. m.roobol@erasmusmc.nl
authors: Monique J
authors: MJ
authors: Roobol
authors: Xiaoye
authors: X
authors: Zhu
authors: Fritz H
authors: FH
authors: Schröder
authors: Geert J L H
authors: GJ
authors: van Leenders
authors: Ron H
authors: RH
authors: van Schaik
authors: Chris H
authors: CH
authors: Bangma
authors: Ewout W
authors: EW
authors: Steyerberg
mesh_terms: D000368:Aged; D055088:Early Detection of Cancer / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D012306:Risk; D018570:Risk Assessment / Q000379:methods
chemical_list: D017430:Prostate-Specific Antigen