Individual risk assessment for prostate cancer: an impact analysis.

The frequency of opportunistic screening for prostate cancer by the use of the
PSA test among men older than 50 years in The Netherlands is estimated to range
between 20 and 40% (www.cbs.nl). Current screening practice leads to many
prostate biopsies, and many of the prostate cancers found are in fact indolent,
i.e., not representing any threat to the patients* health. In the ERSPC
screening study the frequency of indolent cancers is in the range of at least
50%. The current scientific state of the art allows for basing the decision to
take a prostate biopsy or not on individualized risk estimation, so that
biopsies are only taken in patients who are at a relevant risk of having
prostate cancer and the total
biopsy rate is reduced. Similarly, the decision for active treatment or active
surveillance can be based on individualized estimation of the risk of an
indolent prostate cancer.

The proposed project aims at implementing the available scientific knowledge
for recommending biopsies or active treatment, respectively, at the individual
level in Dutch urological practice. To this end we have developed an internet
based decision tool (risk calculator), De Prostaatwijzer ®, which allows to
estimate individualized risks.

The implementation of the Prostaatwijzer® will be prospectively evaluated. For
this at least 600 men in 5 regional medical
centres will be included. Specifically, two decision levels will be addressed:
the chance of finding prostate cancer if a man undergoes a prostate biopsy and,
in case prostate cancer is found, an advice to undergo active surveillance
within a protocol if the chance of indolent prostate cancer is high.

There are no risks associated with participation in the trial. The extra burden
for participants as compared to standard tests consists of filling out a
questionnaire twice. This will cost the patient approximately 15 minutes per
questionnaire.