Intended Use

We currently recommend that CaP Calculator be used by a health care professional experienced in the management of carcinoma of the prostate (CaP). 

Often, controversy or disagreement exists regarding the best clinical practices or expected treatment outcomes.  While we have attempted to make a large body of evidence-based results available in a convenient format for comparing estimates, CaP Calculator is to be used as a resource rather than as a substitute for medical decision-making or treatment.

Here are some of the reasons why CaP Calculator is to be used in the context of an existing relationship between men with prostate cancer and health care professionals:

1. All estimates are based upon patients treated primarily at academic medical centers and could differ (possibly better or worse) in the community setting due to patient or physician bias regarding treatment preferences;
2. Some potentially useful or investigational markers for outcomes prediction used by some may not be widely available (e.g. DNA ploidy) or less widely used (e.g. PSA doubling time, perineural invasion or lymphovascular invasion);
3. Most published data give estimates over a five to ten year time horizon but may not fully reflect the possibility of treatment outcome;
4. Determination of clinical stage and Gleason score may differ based upon the experience and/or clinical judgment of the health care professional;
5. Shifts in clinical stage and Gleason score over the past 10-20 years may results in different outcomes than in currently published medical literature;
6. Because some patients in published studies don’t continue to see specialists if everything is going well, follow-up bias may underestimate the effectiveness of treatment;
7. Fine needle aspiration biopsy does not provide adequate information to use CaP Calculator due to difficulty in accurately determining Gleason score and potentially important additional information on the core biopsies (such as percent positive biopsies);
8. New types of treatment or information not included in CaP Calculator may have important implications for risk assessment and treatment recommendations.

Additionally, everyone interprets the same statistical results differently.  For example, a 10% risk of lymph node involvement may sound reassuring to one patient but may cause another man a great deal of anxiety.  While more detailed information can be helpful, we believe that the anxiety and stress about its implications may be minimized by active discussion of CaP Calculator results with health care professionals.  Therefore, we currently suggest that CaP patients have their health care professional register, use CaP Calculator and review the results together.  Based upon that important discussion, the results can be interpreted and placed in context prior to making decisions regarding treatment.

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