I still remember this patient. A young, African-American man presented to the clinic. He had a strong family history of prostate cancer (father/brother) and requested a PSA test. This was “way back” in 2001; we still did PSA testing pretty routinely … but not in a 45-year-old typically.
He had some vague urologic symptoms so some testing was obtained including a PSA (so technically not screening). Sure enough, his PSA was elevated and he was eventually diagnosed with prostate cancer. What I remember most about the patient, however, was that he wanted watchful waiting instead of any aggressive treatments. Also “way back” in 2001, this was relatively unknown and didn’t really happen. He saw at least two urologists who said he was “crazy”! Few clinical trials were published on the topic in 2001. With some research, he found a clinical trial in collaboration with his urologist he underwent watchful waiting: periodic biopsies and PSAs, but no hormone therapy, radical surgery, etc.
I have lost track of the patient over the ensuing decades, but fast forward to 2019 and watchful waiting for prostate cancer is very much a “thing.” Numerous studies have demonstrated this approach is safe for select men with non-metastatic prostate cancer. In the U.K., researchers created a prognostic tool to aid patients and providers regarding watchful waiting (conservative management) vs. radical management (surgery and/or hormone treatment). This group used several large databases to derive and then validate the tool. Again, this is only for non-metastatic prostate cancer and some groups are not well-represented in their cohorts. Nonetheless, the tool enables patients and providers to put in individual patient data (age, PSA, Gleason score, etc.) to help them decide between treatment approaches. Information is presented both verbally and graphically to include side effects such as erectile dysfunction, incontinence, etc.
The web app takes the externally validated Predict Prostate prognostic model and adapts it to mobile browsers. The prognostic model has been extensively researched with ongoing studies to assist patients and providers in determining the “best” treatment for non-metastatic prostate cancer. The model has been endorsed by NICE and the University of Cambridge Academic Urology Group. Some of the same researchers have also developed Predict Breast Cancer tool.
What providers would benefit from this App?
Patients, residents, mid-levels, urologists, oncologists, primary care providers, and any other provider who treats patients with prostate cancer.
- Evidence-based prediction tool with details on derivation/validation.
- Detailed information on pros/cons including side effects.
- Numerous links to PubMed articles, resources for patients.
- No dedicated app/only a web app.
- Some information may be challenging for patients to input/understand.
- Some graphics may be difficult to view on smaller devices.
The Predict Prostate web app based prognostic tool brings evidence-based decision making for non-metastatic prostate cancer to any device with an internet browser. The app takes individual patient data to provide patients and their providers’ information on prognosis with conservative management versus. radical treatment including potential side effects. If you treat patients with prostate cancer, then this prognostic tool is worth a look.
- Overall Score
- 4.5 stars
- User Interface
- 4.5 stars
Despite the web-only format, the app is easy to complete and view results on mobile browsers.
- Multimedia Usage
- 4.0 stars
Web/mobile based only/requires internet connection. Contains numerous links to references, applicable websites, patient support resources (though all mostly UK-based).
- 5 stars
The app is free.
- Real-World Applicability
- 4.5 stars
A web-based resource that can be used by patients or ideally as part of shared-decision making between a patient and their urologist and/or primary care provider to help inform critical decisions concerning treatment of non-metastatic prostate cancer. Highly recommended for anyone who screens or treats patients for prostate cancer.
- Device Used For Review
iPhone 11 Pro running iOS 13.1.2
- Available for computer and mobile browsers.
Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.