Joseph C. Presti, Jr., MD, FACS, presented “Kaiser Permanente Prostate Cancer Risk Calculator 1.0” for the Grand Rounds in Urology audience in September 2020.
Summary:
Joseph C. Presti, Jr., MD, FACS, Regional Leader of Urologic Oncology Surgery at Kaiser Permanente Northern California, discusses the development of Kaiser Permanente’s new prostate cancer risk calculator and its merits. Dr. Presti explains that older risk calculators tend to oversimplify variables like race, are based on outdated systematic biopsy schemes, and are often poorly calibrated due to the sampling frame used. Using TRIPOD guidelines (transparent reporting of a multivariable prediction model for individual prognosis or diagnosis) and the LASSO (least absolute shrinkage and selection operator) system of selection, Kaiser Permanente researchers determined that the variables that ought to be included in a prostate cancer prediction model are age, race, PSA, body-mass index, family history, number of prior negative biopsies, digital rectal exam (DRE), and prostate volume. They created 3 different models based on this, with the simplest but least accurate including clinical core variables but no DRE and no prostate volume, the second-most accurate including DRE but no prostate volume, and the most accurate including DRE and prostate volume. Dr. Presti notes that all of these models compare favorably to other risk calculators.
Q&A – Summary:
E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, interviews Joseph C. Presti, Jr., MD, FACS, Regional Leader of Urologic Oncology Surgery at Kaiser Permanente Northern California, about Kaiser Permanente’s new prostate cancer risk calculator. They discuss the difficulty of getting urologists and family practitioners to give digital rectal exams (DREs) since they have been found to be a deterrent to men getting screened. Dr. Presti suggests that patients who meet a certain risk threshold based on the calculator that does not include a DRE should then receive one. Drs. Crawford and Presti also discuss the role of PSA, PSA density, and molecular markers in calculating prostate cancer risk.
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How to cite: Presti, Joseph C. “Kaiser Permanente Prostate Cancer Risk Calculator 1.0” September 2020. Accessed Nov 2025. https://grandroundsinurology.com/kaiser-permanente-prostate-cancer-risk-calculator-1-0/
ABOUT THE AUTHOR
Joseph C. Presti, Jr., MD, FACS, is an Adjunct Investigator in the Division of Research and a Physician Researcher in the Delivery Science & Applied Research Physician Researcher Program at Kaiser Permanente in Oakland, California. He is also the Regional Leader for Urologic Oncology Surgery with the Kaiser Permanente Medical Group. Dr. Presti specializes in the evaluation and treatment of urologic cancers. His research focuses on refining detection strategies for prostate cancer.
Dr. Presti earned his medical degree from the University of California, Irvine. He then completed an internship and residency in urology from the University of California, San Francisco. Dr. Presti completed a fellowship in Urologic Oncology at the Memorial Sloan-Kettering Cancer Center in Manhattan, New York.
Dr. Presti’s early work investigated biopsy strategies for improving prostate cancer detection. His current work includes developing and evaluating a risk calculator that uses simple clinical variables to predict a patient’s risk of developing an aggressive prostate cancer. Dr. Presti also studies prostate cancer screening and detection, and he is currently working with the Kaiser Permanente Medical Group’s Department of Adult and Family Medicine to refine their shared decision-making program, which aims to maximize benefits and minimize harms from prostate cancer screening. Dr. Presti also serves as the co-clinical lead for the National KP Prostate Cancer Screening Guideline Team.
