Prostate Cancer Composite Risk

1. See Also
   1. Prostate Cancer
   2. Prostate Cancer Management
   3. Active Surveillance of Prostate Cancer
2. Indications
   1. Prostate Cancer Management decision making tool
   2. Assessment of risk of Prostate Cancer related death based on Prostate Cancer grading, staging and PSA
   3. Used in conjunction with Charlson Comorbidity Index (Comorbidity-Adjusted Life Expectancy)
3. Criteria: Required for the algorithm
   1. Prostate Cancer Staging
   2. Prostate Cancer Grading
   3. Prostate Specific Antigen
4. Evaluation: Stage T1a to T2a
   1. Gleason Score 2-6
      1. PSA <10 ng/ml
         1. Very low risk
            1. Criteria for low risk (see below) not met
         2. Low risk
            1. Three or more core biopsies positive or
            2. Prostate Cancer involves >50% or more of sample or
            3. PSA Density =0.15
      2. PSA 10-20 ng/ml: Intermediate risk
      3. PSA >20 ng/ml: High risk
   2. Gleason Score 7
      1. PSA =20 ng/ml: Intermediate risk
      2. PSA >20 ng/ml: High risk
   3. Gleason Score 8-10
      1. High risk regardless of PSA
5. Evaluation: Stage T2b or T2c
   1. Gleason Score 2-7
      1. PSA =20 ng/ml: Intermediate risk
      2. PSA >20 ng/ml: High risk
   2. Gleason Score 8-10
      1. High risk regardless of PSA
6. Interpretation
   1. See Prostate Cancer Management
   2. Very low risk
      1. Prostate Cancer unlikely to cause serious morbidity or mortality within 20 years
   3. Low and moderate risk
      1. Prostate Cancer unlikely to cause serious morbidity or mortality within 10 years
   4. High Risk
      1. Prostate Cancer could result in serious morbidity or mortality within 5 years
7. References
   1. Brawley (2018) Am Fam Physician 97(12): 798-805 [PubMed]
   2. Mohan (2011) Am Fam Physician 84(4): 413-20 [PubMed]