FAQs
Looking for advice?
More Information
The following websites provide excellent advice and information on treatments and their potential harms:
About treatments:
About potential harms:
Further advice and support:
What if I don’t have all the details needed for the input section?
The model requires all boxes on the 'predict tool' page to be completed. If the biopsy details are unknown, 'No'
can be selected next to 'biopsy data available'. If you select 'No' for this, the Predict Prostate tool will use an average value.
If BRCA status is unknown 'Negative or Untested' should be selected. Positive for either BRCA1 or BRCA2 is considered as positive for this model.
All of the necessary details should be easily available to your prostate cancer specialist.
How do I know that Predict Prostate gives the right answers?
Predict Prostate estimates what would be expected to happen to men with similar characteristics based on past data. The findings are based on men diagnosed in the East of England
but we have also tested the model on over 2,500 men diagnosed in Singapore. To the best of our knowledge the Predict tool should work equally well
for men currently diagnosed. However, Predict Prostate can never say with 100% certainty what will happen to an individual man. Note also that Predict Prostate is likely to be
less reliable in higher risk disease, as very few men with these characteristics were managed conservatively in our data.
The model is intended for newly diagnosed men where conservative management and radical treatment
are both appropriate options. The model also does not preclude the potential need for
deferred radical treatment in the future after initial conservative management, if the disease characteristics change.
If the data used is from patients decades ago won't the predictions it gives be out of date?
These predictions are based on patients diagnosed between 2000 and 2010, and include follow-up for up to 16 years.
In order to carry out long term predictions older data have to be used. It is possible that outcomes of cancers diagnosed today, and treatments used today
will be different, but it is impossible to test this.
How does my ethnicity affect the predictions from this model
If there is no family history or known genetic risk factors (see other sections) then how or if ethnicity affects prognosis is largely unclear. Predict Prostate was built from cohorts of mainly Caucasian men and for this group the model is well-validated. The model has also been tested in a mixed cohort of men of Chinese, Indian and Malay descent and achieves equivalent performance. It has not been tested in men of Afro-Caribbean descent. However recent research has shown that when matched for grade and stage of disease (like for like cancers), men of Afro-Caribbean descent have the same outcomes and prognosis as men of Caucasian origin. Please see these research articles:
Dess RT et al. Association of Black Race With Prostate Cancer-Specific and Other-Cause Mortality. JAMA Oncol. 2019 May 23. doi: 10.1001/jamaoncol.2019.0826.
Sridhar G et al. Do African American men have lower survival from prostate cancer compared with White men? A meta-analysis. Am J Mens Health. 2010 Sep;4(3):189-206. doi:10.1177/1557988309353934.
What use are these estimates when as a patient I will either be cured or not?
Treatment does not work the same for everyone - whilst some people may get a large survival benefit, others may get very little or no benefit.
All patients are at risk of the harmful side effects of treatment. Particularly in older men or men with other long-term conditions,
the overall survival benefits of prostate cancer treatment can be small. This makes choosing whether
or not to have radical treatment a difficult and personal choice.
Predict Prostate tries to give the 'best guess' at the sort of benefits treatment might give a particular patient. This can help inform a personal decision on whether to go for immediate treatment or not.
Potential survival benefits can then be weighed against the possible harms from treatment.
What about MRI?
Magnetic Resonance Imaging (MRI) is now a standard tool used in prostate cancer diagnosis.
The data used for this model were from men diagnosed between 2000 and 2010 when MRI was rarely used, and we did
not have data on MRI-defined lesions, imaging scores (e.g. PIRADS) or MRI targeted biopsies. However, it is
important to note that as yet using MRI data has not been shown to directly improve survival. Its main benefit
so far is in reducing the number of men investigated, better staging the cancer and to guide biopsies.
We have recently assessed how using MRI to stage tumours (determine where they are and extent) and to guide biopsies, may impact the results from Predict Prostate compared
to using clinical staging and systematic biopsies.
In this study the impact of MRI on estimates produced from the model were modest and
overall not very different from using non-MRI based information. Amongst 354 individual
cases the median difference in predicted overall survival was 1% and 2% at 10 and 15 years
respectively. Only 1.6% and 2.3% of patients had a ≥ 10% difference in predicted 10 year
and 15-year overall survival estimates.
Estimated treatment benefit was also unchanged for the majority of cases. Where there was
a discrepancy, the median difference in predicted treatment benefit was 1% at both 10- and
15-years’ time frame. Only 1.4% and 0.6% of patients had a ≥ 5% difference in estimated
10- and 15-year treatment benefit (See Lophatananon et al 2022 in Publications).
Therefore, we believe that the estimates from Predict Prostate both for estimated overall survival
and gain from a treatment can be used whether your diagnosis is made with or without the use of MRI.
A final definitive answer on how MRI will change risk and prognosis prediction will need to await
long-term real-world clinical outcomes from large numbers of men who have had good quality MRI as part
of their diagnostic assessments and this is likely to take many years to be available (10-15 years).
We are expecting that the use of MRI will provide even better assessment of where a man is in terms of
disease extent and histological grade at diagnosis. This in turn will better inform the prognostic
predictions from Predict Prostate (e.g. moving a man from Grade Group 1 to Grade Group 2 or from
Stage T2 to stage T3).
If MRI data and imaging scores are shown in the future to add independent value as a survival
indicator then we will update it into a future version of Predict Prostate.
What if I only had biopsies of the suspicious area seen on my MRI?
Predict Prostate is built around data from men who had biopsies taken from different anatomical parts of their prostate, known as 'systematic biopsies'.
It also allows additional 'targeted biopsies' from lesions seen on MRI to be incorporated into the model. A small number of hospitals may
however only take biopsies from parts of the prostate that look suspicious on MRI. In this circumstance, you should select ‘No’ to
whether biopsy data is available as using only the figures from 'targeted' biopsies may lead to much less reliable estimates.
By reporting that biopsy data is unavailable, the average values will be used, which may make the estimates slightly less personalised.
What about if my biopsies show Intraductal and/or cribriform pattern
These features are considered aggressive variants of prostate cancer and are most commonly associated with high grade group disease. The presence of these variants with lower grade disease (Grade Group1 or Grade Group 2) suggest they will behave more aggressively than expected. The presence of these variants with higher Grade disease is thought to confer a poorer outcome but as yet there is no different treatment offered in addition to standard radical therapy. Predict Prostate did not have data on these variants and hence the estimates for conservative versus radical therapy should be interpreted with extreme caution. Current opinion suggest that conservative management should not be a recommended option for men whose biopsies have these histological features.
Please see these research articles and commentaries
- Kweldam CF et al. Disease-specific survival of patients with invasive cribriform and intraductal prostate cancer at diagnostic biopsy. Mod Pathol. 2016 Jun;29(6):630-6.
- Samaratunga H, et al. Intraductal carcinoma of the prostate is an aggressive form of invasive carcinoma and should be graded. Pathology. 2020 Feb;52(2):192-196.
- Epstein JI. Is There Enough Support for a New Prostate Grading System Factoring in Intraductal Carcinoma and Cribriform Cancer? Eur Urol. 2020 Feb;77(2):199-200.
What if I never had any prostate biopsies and my prostate cancer was diagnosed incidentally by an operation to help me urinate (such as by 'trans-urethral resection of the prostate 'TURP' or 'HoLeP')?
Predict Prostate should not be used in this situation. We suggest you speak to your health care provider.
What about other treatments?
Predict Prostate focuses on whole gland or radical treatment (radical prostatectomy or radiotherapy) compared to conservative management (including active surveillance or watchful waiting).
Other treatments (e.g. partial or focal treatments) have not been considered by this model as there is little or no long-term comparative data of the treatment against conservative management.
Your own prostate cancer specialist should be able to advise you how effective another treatment type is.
What about metastatic cancer?
Predict Prostate must not to be used in men with any evidence of disease outside (or metastatic) the prostate.
Does Predict Prostate account for different types of surgery or radiotherapy?
No. Predict Prostate does not attempt to differentiate between surgery and radiotherapy, nor between different surgical or radiotherapy techniques.
Please see other publications or speak to your specialist about any impact of surgical or radiotherapy approach on treatment survival benefits.
What about side effects?
Information about potential treatment side effects, or harms, is on the 'Predict Prostate Tool' page.
Please note that these are not individualised to your personal details but are taken from the studies reported in the text.
We have used data from recent peer-reviewed publications to derive these values, and where possible, from randomised trials.
You should also speak to your specialist or you can look at the UK National Prostate Cancer Audit patient
reported outcomes for additional information and guidance.
Charities such as Prostate Cancer UK. and Macmillan can also provide useful information on the side
effects of each treatment.
Who developed the Predict Prostate programme?
How was the computer programme developed?
Who designed the website?
The website has been built by the Winton Centre for Risk & Evidence Communication at the University of Cambridge. The site functionality and visualisation software is trademarked by the Winton Centre as
4U2C. However, we are happy for others to use it for similar purposes. Do contact us to discuss this at wintoncentre@maths.cam.ac.uk.
Where can I find more information on prostate cancer?
There is a great deal of information on prostate cancer on the web. One of best and most reliable
sources is Cancer Research UK, along with those from Macmillan and Prostate Cancer UK. Their information is written by experts, is up to date and in a style
that is easy to understand.
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