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 Presti explains that older risk calculators tend to oversimplify variables like race, are based on outdated systematic biopsy schemes, and are often poorly calibrated due to the sampling frame used.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 2024. https://grandroundsinurology.com/kaiser-permanente-prostate-cancer-risk-calculator-1-0/
ABOUT THE AUTHOR
Joseph C. Presti, Jr., MD, FACS, is a urologist at Kaiser Oakland and serves as Regional Leader of Urologic Oncology Surgery for Kaiser Permanente California. Dr. Presti is a Bay Area native, and attended UC Berkeley for his undergraduate education and UC Irvine for medical school. He went on to complete his urology residency at UC San Francisco, followed by a fellowship in urologic oncology at Memorial Sloan-Kettering Cancer Center. He was a member of the faculty at UC San Francisco from 1992 to 2000. He then served as Director of Urologic Oncology at Stanford University for 12 years. Dr. Presti’s research interests have focused on prostate cancer, particularly the refinement of prostate cancer detection strategies.
