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Cleveland Clinic Risk Calc Vs MKCC nomogram

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Posted 3/10/2018 4:57 PM (GMT 0)
Just wondering which one is more accurate.

For my stats there is a 3%(7 Year) to 6%(10 Year) difference in the recurrence rate between the two calculators.

https://www.mskcc.org/nomograms/prostate/post_op

http://riskcalc.org/ProstateCancerPredictingPostRadicalProstatectomy/

at the end of the day its a stat - but just have nothing else to go over the weekend.

Also since we are on comparisons, another question for giggles...which is better of the two evils ( from PC Point of View)... Wine or Scotch.
Posted 3/10/2018 5:45 PM (GMT 0)
The nomograms are, I believe, based on each specific treatment centers database. Also, a few % points could just be statistical noise.
I wonder if the Cleveland clinic database uses more recent numbers. I looked at their SRT nomograms, and it allowed me to input very low values for Pre-SRT PSA , like .05. The MSKCC nomograms doesn't allow any pre SRT PSA under .2.

I also noticed a difference between the two.

Interesting to note that I ran the CC calculator with .06 pre SRT PSA and also with .2, and the difference was not significant enough to be meaningful. And that is with both positive AND negative margins
Posted 3/10/2018 6:50 PM (GMT 0)
I think nomograms are not reliable except when all your data lie in selected ranges where they have been fitted to work. For instance, in the one on risk after bcr, preoperative psa and time to bcr work in a counteintuitive way, probably wrong except for selected cases. It is not as sensitive to Gleason grade, T3b or positive nodes as you could expect. And time to doubling psa is by far the most sensitive parameter. If you cannot give a good estimation, the results are always optimisitc but unfortunately close to irrelevant. The ones on survival after prostatectomy are also too optimistic and not reliable for high grade. This is my opinion, others may differ.
Posted 3/10/2018 7:12 PM (GMT 0)
Nomograms typically have reliability in the 65-75% range. One of the problems is the sample size can get very small for some groups. That's what Pratoman ran into - very few men in their database were treated based on uPSA below 0.2, so reliability of such small samples is low. You have to look at more focussed database analyses and clinical trials for more reliable info for particular situations.

MSK is still using the 2007 data from Cleveland Clinic for their nomogram predicting success of SRT. Cleveland Clinic updated their data last year with a bigger sample size, so you should take the new one as more accurate.

/pcnrv.blogspot.com/2016/08/probability-of-remaining-recurrence.html
Posted 3/10/2018 8:02 PM (GMT 0)
Both are good.

Remember, neither tell you what is going to happen to YOU.

Use the nomograms to gauge how big of a fight you have in front of you...either of those two will give you the same message in that regard.
Posted 3/10/2018 10:38 PM (GMT 0)

ddyss said...
...which is better of the two evils ( from PC Point of View)... Wine or Scotch.


Let’s do a controlled study. You have 3 glasses of scotch a night for one month, and I’ll have 3 glasses of wine. At the end of the month, if we’re still standing, we’ll get PSAs. I’m not sure what that’ll tell us, but it can’t be totally devoid of scientific value, can it?
Posted 3/10/2018 10:52 PM (GMT 0)
If scotch was bad for prostate cancer, I'd probably be dead. Same for good red wines. smilewinkgrin
Posted 3/10/2018 11:12 PM (GMT 0)

garyi said...
If scotch was bad for prostate cancer, I'd probably be dead. Same for good red wines. smilewinkgrin


In a pre-op interview with a resident on my surgeon’s team, after he had gone over pre-op dietary restrictions, my wife asked, “Doctor, what about alcohol?”
“What about it?”
“It’s not good for the prostate, is it?”
“Mrs. Paradise, his prostate is already bad. That’s why we’re going to take it out.”
Posted 3/10/2018 11:16 PM (GMT 0)

Saipan Paradise said...

garyi said...
If scotch was bad for prostate cancer, I'd probably be dead. Same for good red wines.

In a pre-op interview with a resident on my surgeon’s team, after he had gone over pre-op dietary restrictions, my wife asked, “Doctor, what about alcohol?”
“What about it?”
“It’s not good for the prostate, is it?”
“Mrs. Paradise, his prostate is already bad. That’s why we’re going to take it out.”

You obviously have the right surgical team. smile
Posted 3/10/2018 11:44 PM (GMT 0)
Thanks All !

Saipan, I’m up for the study! Let’s submit a NIH grant and we can have a larger HW member only study group. Recruitment, I think, won’t be a big problem! And maybe we can add Beer as a variable.
Posted 3/10/2018 11:57 PM (GMT 0)
Question on the Cleveland Clinic calculator — is Capsule Invasion Type from DRE or pathology and what is the type Inv.Capsule? You can enter that EPE is Yes but have Capsule Invasion Type as None. Makes me think Capsule Invasion from DRE?
Posted 3/11/2018 2:14 AM (GMT 0)
Maybe MRI , I’m guessing but I had capsule invasion in my MRI report.
Posted 3/11/2018 2:17 AM (GMT 0)
Saipan ,
I got the study started but I’m cheating a little - my choice for the study is Knob - Rye- whisky. I’ve heard that Rye helps in keeping bad guys at bay.
Posted 3/11/2018 4:52 AM (GMT 0)
I think Tall Allen was spot on when discussing smaller sample size in certain populations. In my case, as a 44 year old GS 3+4 with a low PSA...when I was messing around with the stage, T2a, b, or c...were actually identical. But it was even weirder if I selected T3...in that case, seven year recurrence was 91% vs 94% for ten year recurrence. In their notes they are referencing completely separate studies for the seven and ten year results. That's just a bit odd in my opinion and probably causes some of these unusual results.
Posted 3/11/2018 10:28 AM (GMT 0)
Like RickTrin, I too don’t understand what capsular invasion is and how it is distinct from EPE. Would appreciate an answer.
I’m glad to see that our study of ADH, alcohol dispersion therapy, is proceeding apace and has expanded to include beer and rye whiskey. Btw, my dosage is administered PO, not IM.
Posted 3/11/2018 10:36 AM (GMT 0)
If you want to have a test about how strange the nomogram results may be, just go to the CC nomogram for PCa specific death risk after bcr. Do not include a psa double time period to increase sensitivity of the other variables. Introduce a preoperative psa below 10, for instance 5. Then, repeat with a high value, for instance 80. Risk becomes much lower, almost null.
I guess they introduced a inverse risk for psa increase to comply with the "very low psa" high grade cases, but the results at the other side of the scale (very high psa) are just.... curious.
Posted 3/11/2018 11:54 AM (GMT 0)
ddyss

Nomograms on a weekend??? I can think of 78 things to do before I would settle into comparing non-comparable nomograms!! And commiserating over a difference that is insignificant and not statistically valid. We need to get you out more!

Remember, they are not predictive. For many, but not all, they can be directional, but all have inherit bias and are only based on very limited and different universes. They are but one data point to consider when assessing the disease and planning a treatment direction.

And to your very important question, the answer is, of course, a martini.......Titos vodka, a bit dirty, with three blue cheese stuffed olives. I started drinking a couple of these a week after my radiation was completed and I have been PSA undetectable for more than seven years. What more proof do you want than that nomogram??
Posted 3/11/2018 1:07 PM (GMT 0)
I'll agree with JNF on the implied "how did you find this to waste time on for the weekend?"

I wind up reading most of the posts, so you dragged me into the morass with you.

But as to "best libations", it has to be single malt scotch whisky. I first learned to drink it (didn't say like, at first) while assigned to Moscow. We were too low on the totem pole to get Jack Daniels at less than $100 US per liter, so went on a mission, winding up at the British Embassy store staring at custom bottles of Glenfiddich 18 year old intended for diplomatic events. But it was there, we were there, and it was the rough equivalent of $9.75 US per 1.75 liters. The match was lit.

When I was diagnosed with PCa, I suddenly no longer was the "young and vibrant" picture the company wanted, so they took me off the road and put me on the help desk. But over the following years I met and shared bottles with custom cigar blenders, Master Distillers, and now good friends in the Scotch business. Last night I picked up an Arran Bothy batch 3, which will be on the GFMPH table in a few weeks.

I like to think that "research" has helped me still be here 9 years after I was told 3 years was optimistic.
Posted 3/11/2018 5:00 PM (GMT 0)
Oban all the way.
One time driving south from Fort William on the two-lane and only road to Glasgow, an accident shut both lanes about a mile in front of us. A local woman turned her car around, and when she got next to me she said, “Follow me to the open road.” I did, discovered she was taking us not to an “open” road but the road through Oban, and have never forgotten the Scottish pronunciation.

On nomograms, looks like CC is using the updated Tendulkar data that is more recent than Stephenson’s and accounts for ultrasensitive tests and also lower starting points for SRT.
Posted 3/11/2018 11:01 PM (GMT 0)
Interesting that the C.C. calculator shows higher odds of recurrence for a 3+4 with EPE+ and margins- than for margins+ and EPE-. Isn’t that opposite of how early treatment post RP is typically recommended?
Posted 3/12/2018 2:26 AM (GMT 0)
JNF/142, yeah I agree - monogram is not the best use of the weekend. I did finish Dan Brown’s new novel - Origin. It would be a good book of the month. Dan has done his research well especially for a cancer diet. Cashless , looks like he took some pages from you.
Posted 3/12/2018 2:57 AM (GMT 0)

142 said...
I'll agree with JNF on the implied "how did you find this to waste time on for the weekend?"

....Glenfiddich 18 year old & Arran Bothy batch 3, which will be on the GFMPH table in a few weeks.

I like to think that "research" has helped me still be here 9 years after I was told 3 years was optimistic.

No kidding turn

Two elixirs of the Gods cool

That “research” is yours’ not theirs!
Posted 3/12/2018 5:14 AM (GMT 0)
My son brought me a bottle of scotch for Christmas...glenlivet..never had it before{scotch and I am scotch/Irish}...mainly a hi octane IPA or champagne guy...but I rapidly acquired a taste for it...and have sadly abandoned tasting it again...once the bottle was goneand ...as I have mentioned...I have an addictive personality...and whiskey is too dam easy...and waaay to relaxing....the same goes for any herbal medicine...as it...goes hand in glove with tobacco...yes my dirty little secret...its been 5 full months since any kine smoke or vape has passed thru my longs...and edibles/oils were never for me...I swear on me mithers grave I have never...zip...zero put a thought to pen...E or other wise...with a herbal waft...I can not say the same for a couple of if icy cold loaded ipa's. I do mostly the stone ipa's at home cause they are ez to get here...plus an occasional session at MonkeyPods...beautiful bar and restaurant in Kihei...check it out if you are ever on Maui...many,,,many taps of all kine beer served at 28 degrees...with beauty...constantly gliding...across the floor...ahh it brings a tear to me eye...yes my wife of 37 years is always with me...to drive us home...as far is the beauty glides...she smiles...a real saint ...that one...

PS I'm curious...I know MSKC has as their "official" bcr mark as .4...I wonder if that number is the mark they use in their nomogram as well...be advised various medicos employed there have various benchmarks of their own based on their on predilections and expierience and...this must be said...based on their perception of patient anxiety...verbal and nonverbal cues presented by the patients...and the general pressure put on them by some patients...in their quest for the balm of all balms...the magic bullet...the being behind the opening door in their mind...that will say...'all is well...all is well...my child'...this leaning of the narrow...is not...insignificant.... : redface
Posted 3/12/2018 5:33 AM (GMT 0)
LOGO- Congraulations on the 5 months! i quit on July 15, 1983 still remember it you are right it is very addictive!! Now with all that money you are saving you can take out that saint for a few more meals at MonkeyPods. turn


Larry
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