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Clinical calculator summary

Johns Hopkins Epstein T1c Pretreatment Criteria (1994 derivation; 1997 operational thresholds)

This route interprets the familiar four-threshold Johns Hopkins operational criteria prospectively described in 1997.

Evidence-based context for fast calculator use

Purpose:
Strict historical interpreter of the four 1997 operational thresholds used after the 1994 Johns Hopkins cT1c derivation.
Population:
patients undergoing prostate cancer diagnostic, pathologic, recurrence, or molecular-risk assessment
Factors:
PSA density, Biopsy Gleason context, Number of involved biopsy cores, Maximum cancer involvement in any core
Reference:
Epstein et al., JAMA 1994;271:368-374 (PMID 7506797). Operational reference: Carter et al., J Urol 1997 (PMID 9146616). Limitation review: Lee et al., BJU Int 2011 (PMID 21320276).
HomeJohns Hopkins Epstein T1c Pretreatment Criteria (1994 derivation; 1997 operational thresholds)
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Johns Hopkins Epstein T1c Pretreatment Criteria (1994 derivation; 1997 operational thresholds)

ng/mL/cm3
%

Clinical Context & Background

This route interprets the familiar four-threshold Johns Hopkins operational criteria prospectively described in 1997. It does not claim that this simplified checklist is the literal full 1994 derivation model.
The historical endpoint was prediction of pathologically insignificant disease in the prostatectomy specimen among adults with newly diagnosed, nonpalpable cT1c acinar adenocarcinoma assessed before treatment using systematic needle-biopsy sampling comparable to the source setting.
The output is not a natural-history, metastasis, mortality, treatment-benefit, or modern active-surveillance eligibility result. It does not recommend surveillance or treatment. Targeted-only, saturation, mapping, MRI, genomic, molecular, treated, postoperative, nonadenocarcinoma, nodal/metastatic, cT1a/b, or cT2+ contexts are outside this historical model.
Primary Source EvidenceEpstein et al., JAMA 1994;271:368-374 (PMID 7506797). Operational reference: Carter et al., J Urol 1997 (PMID 9146616). Limitation review: Lee et al., BJU Int 2011 (PMID 21320276).
Formula Logic
Applicable historical interpretation meets only when PSAD <0.15, Gleason score <=6 with no pattern 4/5, involved cores <3, and maximum involvement <50%. Equalities 0.15, 3, and 50 fail.

Reference Data

Operational criterionExact ruleMeaning
PSA density<0.15 ng/mL/cm3Historical threshold
Biopsy gradeScore <=6, no pattern 4 or 5Historical threshold
Involved cores<3Historical threshold
Maximum involvement<50%Historical threshold

Clinical Workflow

Use, Interpret, And Continue The Patient Pathway

Expand for workflow guidance, limitations, examples, and related next steps.

When To Use

  • Use Johns Hopkins Epstein T1c Pretreatment Criteria (1994 derivation; 1997 operational thresholds) when strict historical interpreter of the four 1997 operational thresholds used after the 1994 Johns Hopkins cT1c derivation.
  • Confirm that the patient, diagnosis, disease phase, and available inputs match the cited model before calculation.

How To Interpret

  • Interpret the displayed result using the calculator-specific formula and reference table, spanning PSA density through Maximum involvement.
  • A boundary result should prompt input verification and clinical review rather than false precision.

What To Do Next

  • Confirm biopsy versus prostatectomy setting, PSA timing, grade group, clinical/pathologic stage, imaging, life expectancy, and treatment history.
  • Document the inputs, result, timing, and clinical context so the assessment can be reproduced.

Limitations

  • Diagnostic, post-prostatectomy, genomic, and recurrence tools must be used only at their intended decision point.
  • The result supports clinician judgment and does not independently determine treatment.

Validated Population

patients undergoing prostate cancer diagnostic, pathologic, recurrence, or molecular-risk assessment

How to apply this result

For a representative case, verify PSA density, Biopsy Gleason context, Number of involved biopsy cores, calculate the result, and confirm that its classification matches the highlighted reference band before continuing the disease-specific pathway.

Prostate Cancer hubContinue to related calculators and clinical workflow resources.

Calculation verification history

Verified

  1. : Production browser revalidation

    • Three source-backed cases passed through visible production controls across the qualifying profile and PSAD/core failure boundaries.
    • All four historical criteria were evaluated as expected.
    • No unexpected N/A, literal undefined value, stale control, unsupported gauge, or browser-console error was observed.
    Download latest production check (Excel)

    Case-level evidence is retained in validation/browser-revalidation/epstein-prostate-cancer-surveillance-2026-08-03.json.

  2. : Production browser validation

    • Ten source-backed cases were exercised on the public production route through visible browser controls; 10/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
    • Overall browser status: failed-console. medium: Production emitted minified React error #418 during the route load.
    • Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.

    Case-level production evidence is retained in validation/browser-production/epstein-prostate-cancer-surveillance.json.

  3. : Public form simplified

    • Reduced nine public questions to one early historical-model applicability confirmation plus the four result-determining thresholds.
    • The adapter projects confirmed cT1c, disease, timing, sampling, and contemporaneous PSA-density context into the unchanged strict nine-key engine.
    • Canonical browser numbers now reach the strict engine without the prior string-only mismatch; 496/496 engine checks and the shared compact-adapter audit passed.

  4. : Calculation corrected

    • Replaced defaulted, pre-binned, coercive inputs with a strict nine-key raw-value contract and exact 1997 operational inequalities: PSA density <0.15, fewer than 3 involved cores, and maximum involvement <50%.
    • Added explicit grade identity, source/version trace, finite and safe-integer checks, exact-object validation, no rounding, no mutation, and neutral invalid or incomplete output.

  5. : Applicability and language corrected

    • Locked applicability to newly diagnosed acinar adenocarcinoma, cT1c, pretreatment, comparable systematic needle-biopsy sampling, and contemporaneous PSA density.
    • Separated the 1994 derivation from the 1997 operational thresholds and removed automatic active-surveillance candidacy, clinically-significant-cancer labeling, and treatment directives.
    • Replaced the prostate panel's duplicate Epstein logic with the canonical full-precision projection while leaving the panel In review.

  6. : Validation completed

    • Passed 496/496 deterministic implementation checks using an independent oracle: 24 identity/source/scope, 216 exhaustive threshold-state, 48 equality/precision, 96 malformed-envelope, 32 UI/reset, 48 panel parity/isolation, 16 trace/language/immutability, and 16 registry/report/history checks.
    • This is software implementation verification, not prospective or independent clinical validation.

Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.

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Frequently Asked Questions

When should Johns Hopkins Epstein T1c Pretreatment Criteria (1994 derivation; 1997 operational thresholds) be used?

Use it for patients undergoing prostate cancer diagnostic, pathologic, recurrence, or molecular-risk assessment when all required inputs and the intended clinical setting are confirmed.

Can Johns Hopkins Epstein T1c Pretreatment Criteria (1994 derivation; 1997 operational thresholds) determine treatment by itself?

No. Interpret the result with the cited evidence, complete clinical assessment, current guidelines, and patient-specific goals.

Evidence-based oncology decision support. Verify with clinical guidelines.