New Prostate nomogram especially useful for gleason 7s

Tks An - I will have a look at it now..............Cheers Kev.

I used the nomogram and it rather oddly increased my odds of survival from 94 to 95% when answering "yes" to EPE versus "no."  My stats are 3.2; 29 gm; 30% Grade 4;  EPE+ and "no" to the rest.  Very strange.

An,

I am most impressed. This is only one of these that ever had my situation reasonably accurate. Punched my numbers in, and showed me being at 1 out 3 chance of a "cure" at 3 years. I had BCR at 9 months. Most of the more commonly used ones were overly optimistic about my numbers.

Thanks

David in SC

reachout - I believe you would use 60% in the calculation, but I am not a doc and could be wrong. I base this on what I read in this article: jama.ama-assn.org/content/281/15/1395.long (free) which is linked to from the nomogram. Excerpt below:

"The Stanford modified Gleason scale was used to estimate the proportion of each cancer that was poorly differentiated in all 379 radical prostatectomies.6 Briefly, from the Gleason scale of 5 grades,1​ grades 4 and 5 (poorly differentiated) constitute a variety of histological patterns having the common feature that they do not form intact gland units mimicking normal architecture. Grades 4 and 5 contrast sharply with Gleason grades 1, 2, and 3, all of which form complete gland units and appear to have similar favorable prognostic significance.7 Accordingly, we combined grades 1, 2, and 3 into a single well-differentiated category. The percentage of each cancer occupied by Gleason grades 4 and 5 (% Gleason grade 4/5) was estimated by a single pathologist (J.E.M.) and performed prospectively before biochemical failure was detected by serum PSA findings. These % Gleason grade 4/5 data were compared with the Gleason scores, in which the 2 most prevalent grades in each cancer are added together and used as a sum or score. Most commonly, the score reflects 2 adjacent grades (ie, 3 + 4=7 or 4 + 3=7) or cancers of pure grade (ie, 3 + 3=6). For a score of 7, the proportion of Gleason grade 4 cancer may vary between 5% and 95% without altering the score (sum). To use the traditional Gleason scoring system, fractional areas of tumor less than 5% of the total tumor area should be ignored; if the secondary grade is less than 5%, the primary grade (most common) is simply doubled to obtain the score. "

I should know this, but just what is meant by "intraductal cancer of the prostate" on the nomogram?  It has a "yes/no" answer. 

What I gleaned from google is that it is better if you don't have it as it is usually related to high gleason scores, advanced cancer, EPE pos margins etc. Not much help but i never heard of it before either. I know intra means within inter means among. In previous job, intrafacility coordination,meant coordinating within the facility, interfacility coordination was coordinating with other facilities other than your own, suffice to say that muddies the water somewhat.

AJ, my numbers go down 3% with EPE, which is the right direction

AJ, I'm 83.9% with and 86.57% without. In your case I think the problem is that you are so close to 100% that there is no real difference between with and without. Actually, in both our cases, I'm surprised that EPE makes such a small difference. Positive margins is much more important.

But here again, the devil is in the details. The nomogram predicts a "PSA cure" which I think is an unfortunate term. What it means, I think, is the chance for PSA remaining less than BCR, which usually means 0.2. That doesn't mean a "cure" in the sense of the cancer not ever coming back.

Positive margins, I understand, is a good thing to have if the PSA comes back because it indicates it's probably a local occurence that can be treated with radiation.

Hi David,

Yes I was also impressed by the nomogram and also by speaking to Dr Cohen. His findings are that the % of Gleason 4/5 and positive margins have the biggest impact on the outcome.

 

Hi Reachout,

The % of Gleason 4/5 that he is referring to is the % out of the total prostate cancer that is Gleason 4/5. So in your example this would be 60%. I know this for a fact because I went to him for a second opinion on Paul's pathology, post RP. His view was that Pauls PC was 30% Gleason 4/5 as opposed to the first pathologist who said it was only 5% Gleason 4/5. He said this did make a difference, increasing the likelihood by a couple of % points of a recurrance. Paul's chances of a recurrance are about 4.5% according to Dr Cohon's nomogram using 30% Gleason 4/5 and 2.5% using 5% Gleason 4/5. A small but significant difference.

Regards,
An

even though they are just numbers and we all react to treatment differently - the results for mine - 85.5% - are encouraging for me.
-still enjoying my pudgey anti-cancer diet (with a little cajun seasoning thrown in)
hugs,
BRONSON