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Question on MSK nomogram

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Posted 7/10/2015 5:52 PM (GMT 0)
I had my 6.5 years PSA test and it was <0.01. I plugged my numbers in the nomogram and it shows that I have a 95% probability of being cancer free for 7 years (only six months away) but only 75% for 10 years and 92% for 15 years. Why does the percentage drop from 95% to 75%?
Posted 7/10/2015 5:59 PM (GMT 0)
Computer glitz... That or user error.. You are after all getting OLD.

<<<runs and ducks for cover>>>

How's it going down south Ed confused
Posted 7/10/2015 6:05 PM (GMT 0)
I assume that you transposed your numbers and it is 92% at 10 years and 75% at 15 years. If so, the reason is simple, people fail over time. The more time, then more people that fail. Conversely, the longer you go without failure, the less likely you are to fail.

What I don't get about the nomogram, is that it asks how long you have been cancer-free, but ignores that input when giving your result. For example, if you input that you have been cancer free for 8 years, it still won't tell you that you have a 100% chance of being cancer free for 7 years post-surgery.
Posted 7/11/2015 4:59 PM (GMT 0)
No my numbers are as indicated. it goes from 95% at 7 years to 75% at 10 which doesn't seem to make sense. The 92% at 10 years is probably because many will die of other causes not related to PC.
Posted 7/11/2015 5:02 PM (GMT 0)
By the way, here are the numbers I plugged in: PSA 3.7, Gleason (4+4) No margins, EPE no on everything else.
Posted 7/11/2015 10:31 PM (GMT 0)
" I have a 95% probability of being cancer free for 7 years (only six months away) but only 75% for 10 years and 92% for 15 years. Why does the percentage drop from 95% to 75%?"

I would assume (and I am probably wrong) but the jump from 75% @ 10 yrs up to 92% @ 15 yrs probably reflects that if you survive for 10 years cancer free then you probably remain free of cancer for the next 5 years.

My 2 cents worth.
Posted 7/11/2015 10:36 PM (GMT 0)
One of the data points that you are required to plug in to the nomogram is "how many months have you been PSA Undetectable, i.e. how many months since RP"
So my question is, when they calculate your chances of being cancer free for 2, 5, 7 and 10 years, is that chance of cancer free 2,47, and 10 yearsfrom date of RP, or is that from the date you are imputting the data? I always assumed it was from the date of RP, so after 10 years, it was just anybodies guess. But i wonder. I's sure someone here knows.

Post Edited (Pratoman) : 7/12/2015 7:03:40 AM (GMT-6)

Posted 7/12/2015 12:11 PM (GMT 0)
I did put the number of months that I have been cancer free from the surgery date (78 in my case).
Posted 7/12/2015 2:44 PM (GMT 0)
I attach zero credibility to any tools like this - I think they are designed for peace of mind but rarely achieve that. I always remember the doctors telling me they got all my father's cancer and were 99% certain he would live a long and healthy life......you can guess the rest and what happened six months later.
Posted 7/13/2015 11:23 PM (GMT 0)
"We" I sure appreciate what you said about your dad....I would not believe stats. either unless there were some really long term data to cross reference it to. I can tell you with your pathology you can be sure you will live a long life, at least from prostate cancer. I have searched and searched the web over and over for 6 years and you will out live your PCa....

The last 30 year study I read from J.H. showed men with your stats. had no deaths up to 30 years out and counting....

I am also amazed someone sent you for a bone scan, MRI and CT scan with your initial pathology.....It's almost criminal and really pisses me off when I read about doctors sending people out with your stats. for all those tests....The number of men found with extensive disease and our stats. at scan time is about 0 if not 0.

The guy is either a scam artist or doesn't have any idea what he is doing when it comes to PCa. Don't care who he is...

Post Edited (ChrisR) : 7/13/2015 5:26:24 PM (GMT-6)

Posted 7/14/2015 2:11 AM (GMT 0)
Chris,

I understand where your comments are coming from but all those tests were my choice and to a reasonable degree at my cost (fortunately I can afford it). They were for peace of mind and I'm glad I did them. 30 years would be good, but I'm taking it six months at a time !

We can do this.
Posted 7/14/2015 3:19 AM (GMT 0)
We,
Sorry about your dad. But I have to disagree about the nature of nomograms and statistics. I've edited several hundred scientific and medical papers in the past and I have to say that the language of science, regardless of discipline (e.g., medicine, biochemistry, etc.), is statistics. Results are reported based on confidence intervals of a population studied. So it might be said, for example, that with 95 percent confidence I have an 60 percent probability of biochemical recurrence within 10 years. With luck, I may be in the 40 percent who do not have recurrence. Or with less luck I might be be in the 60 percent who have a recurrence. Or then again there is always the 5% chance that the 95% statistical confidence of the model is not valid. In any individual case any one of us might be either better or worse at some point in the future. But such models are not bad tools. In the aggregate the model should hold true for the average of the the entire population.

In a more perfect world, medicine would be more personal. But so far the best we can do is plug our individual clinical signs into larger statistical populations and then see what our probabilities are -- this is the way our doctors think. Imperfect as it is, it is the best model they, or we, have to work with.

Jim
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