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MSKCC nomogram predicts survival for
patients who fail androgen ablation therapy (November, 2002)
This nomogram was presented by
physicians from Memorial Sloan-Kettering Cancer Center, Cornell
University, and UCSF-Mount Sinai Cancer Center in the Journal of Clinical
Oncology, October 1, 2002:pp 3972-3982. The MSKCC nomogram allows
prediction of survival of patients with progressive metastatic prostate
cancer who have FAILED androgen ablative therapy. The basis of this data
is the outcome of 409 patients treated at MSKCC between 1989 and 2000 on
19 different therapeutic protocols utilizing chemotherapy and a wide
variety of treatment combinations. These patients exhibited (alone or in
combination) rising PSA's, new bone metastases or increasing soft tissue
disease. The usefulness of the nomogram is that it employs data that is
routinely available in the clinical setting when treatment options are
discussed, i.e., age, Karnofsky performance status, hemoglobin, alkaline
phosphatase, LDH, PSA, and albumin. To an experienced clinician the
results are fairly intuitive with one exception. As expected, patients do
poorly if they are symptomatic because of low performance status,
decreased HGB and albumin, or high LDH. The interesting observation is
that PSA BY ITSELF is not an independent predictor of survival. A PSA up
to 100 contributes only to a small degree in predicting a poor survival
and a PSA from 100 to 8450 is virtually insignificant in predicting
survival if a patient is free of the other adverse factors. That piece of
data by itself can be encouraging to a patient who feels well and exhibits
only a rising PSA. The nomogram presents data for probability of median
survival and of 1-year, 2-year survival probabilities.
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