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description: 'Clinical decision support for prostate cancer: risk stratification (NCCN/EAU/CAPRA), LNI prediction (Briganti/Roach), PSADT/BCR assessment, salvage RT planning, and Polish NFZ drug programmes (B.56 for apalutamide/darolutamide/enzalutamide/olaparib/niraparib/talazoparib, C.87 for abiraterone). Covers mHSPC, nmCRPC, mCRPC eligibility, qualification criteria, dosing, and monitoring.' name: prostate-cancer-calculator routing_description: Clinical decision support for prostate cancer risk stratification, biochemical recurrence assessment, and Polish NFZ drug programme qualification across NCCN/EAU/CAPRA risk models and systemic therapy recommendations. routing_keywords:

• prostate cancer
• psa
• gleason score
• grade group
• nccn risk
• eau risk
• capra score
• lni prediction
• biochemical recurrence
• psadt
• salvage radiation
• apalutamide
• darolutamide
• enzalutamide
• abiraterone
• mcrpc
• mhspc
• nmcrpc
• polish nfz
• briganti nomogram
• roach nomogram
• adt duration

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Prostate Cancer Clinical Calculator

Overview

Comprehensive clinical decision support for prostate cancer across:

1. Risk Stratification: NCCN/EAU risk groups, LNI prediction nomograms
2. Biochemical Recurrence: EAU BCR risk, PSADT, salvage RT decisions
3. Polish NFZ Drug Programmes:
   • B.56: Apalutamide, Darolutamide, Enzalutamide, Olaparib, Niraparib+Abiraterone, Talazoparib
   • C.87: Abiraterone (C.87.a/C.87.b)

Quick Start

Import and use the helper script:

Copyfrom helper import *

# Primary risk stratification
nccn = calculate_nccn_risk(psa=12, grade_group=3, t_stage="T2b", 
                            positive_cores=4, total_cores=12, psa_density=0.18)
eau = calculate_eau_risk(psa=12, grade_group=3, t_stage="T2b")

# LNI prediction
briganti = briganti_2017_lni(psa=15, t_stage="T2", grade_group=3, 
                              pct_positive_highest=50, pct_positive_lowest=25)
roach = roach_lni(psa=15, gleason=7)

# BCR assessment
psadt = calculate_psadt([(0, 0.15), (90, 0.35), (180, 0.72)])  # (days, PSA)
eau_bcr = eau_bcr_risk(psadt_months=8, grade_group=4, time_to_bcr_months=12)

# Salvage RT recommendations
pelvic_rec = pelvic_node_recommendation(pre_srt_psa=0.5, lni_risk=18)
adt_rec = adt_duration_recommendation(pre_srt_psa=0.8, grade_group=3, psadt_months=10)

Reference Files

Available Functions

Risk Stratification

LNI Prediction

BCR Assessment

Salvage RT Decisions

Polish NFZ Drug Programmes

Key Thresholds

Clinical Decision Algorithm

CopyPRIMARY TREATMENT
├── Calculate NCCN + EAU risk group
├── If intermediate/high risk → Calculate LNI risk
│   ├── Briganti ≥7% → ePLND recommended
│   └── Roach ≥15% → Pelvic RT if definitive RT chosen
└── Document CAPRA score for prognosis

BIOCHEMICAL RECURRENCE (post-RP)
├── Calculate PSADT (≥3 values, ≥3 months)
├── Classify EAU BCR risk (low vs high)
├── If high-risk BCR:
│   ├── Pre-SRT PSA >0.35 → Add pelvic nodes to RT
│   ├── Pre-SRT PSA ≥0.7 → Consider long-term ADT (24 mo)
│   └── PSADT ≤9 mo + PSA ≥1 → Consider enzalutamide (EMBARK)
└── If low-risk BCR → Observation may be appropriate

Important Notes

• Briganti 2017 uses published beta coefficients; other Briganti versions require lookup tables
• Roach formula overestimates contemporary LNI rates but remains useful for RT field decisions
• PSADT calculation requires ≥3 PSA values over ≥3 months, all rising, same assay
• ADT recommendations integrate GETUG-AFU 16, RTOG 9601, and RADICALS-HD evidence
• Always document genomic classifier (Decipher) when available—modifies ADT recommendations

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Polish NFZ Programme B.56 - Drug Selection Guide

Drug Availability by Disease Stage

*Requires BRCA1/2 or HRR gene mutations

Key Programme Rules

1. ONE new-generation hormonal therapy line allowed per patient
2. ONE PARP inhibitor line allowed per patient
3. One-time use of non-steroidal antiandrogen AND PARP inhibitor permitted
4. All patients must maintain castration (LHRH agonist/antagonist or orchiectomy)

Performance Status Requirements

Dosing Quick Reference

Common Exclusion Criteria

• Prior abiraterone (except specific exceptions for Niraparib+Abi)
• Prior novel hormonal agent (for PARP inhibitor combinations)
• Seizure history (Apalutamide, Enzalutamide)
• CrCl ≤30 mL/min (PARP inhibitors)

Decision Tree

CopyPATIENT PRESENTS
├── mHSPC?
│   ├── Can receive docetaxel? → Darolutamide + Docetaxel
│   └── Cannot/prefers not → Apalutamide OR Enzalutamide
│
├── nmCRPC? (M0, PSADT ≤10 mo, testosterone ≤50 ng/dL)
│   └── Apalutamide / Darolutamide / Enzalutamide
│
└── mCRPC?
    ├── BRCA1/2 mutation?
    │   ├── Progressed on hormonal therapy → Olaparib
    │   └── 1st line, no chemo indication → Niraparib+Abiraterone
    ├── HRR mutation (BRCA2, ATM, CDK12, etc.)?
    │   └── 1st line, no chemo indication → Talazoparib+Enzalutamide
    └── No targetable mutation → Enzalutamide

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Polish NFZ Programme C.87 - Abiraterone

Attachment C.87.a (High-intensity settings)

1. mHSPC high-risk (≥2 of: Gleason ≥8, ≥3 bone mets, visceral mets)
2. mCRPC pre-chemotherapy (asymptomatic/oligosymptomatic)
3. mCRPC post-docetaxel (after chemotherapy failure)

Attachment C.87.b (Standard settings)

1. mCSPC (not meeting C.87.a high-risk criteria)
2. nmCRPC (PSADT ≤10 months)
3. Adjuvant post-RT (high-risk: N+ or ≥2 of T3-4, Gleason 8-10, PSA ≥40)