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Nomogram Update:
"Preoperative Nomogram Predicting the 10-year Probability
of Prostate Cancer Recurrence After Radical Prostatectomy"
(June 2006)
Michael Kattan and colleagues published a nomogram update (JNCI
, May 17, 2006;98:715-7 ) extending the preoperative predictions to 10
years as compared to the frequently used earlier version (1998) with its 5
year predictions. The 1998 nomogram that so many clinicians consult on
their Palm Pilots or the Web has served as "the most widely used
disease-specific prediction tool in oncology" - for patient counseling,
clinical trial design, or decisions regarding adjuvant therapy. The
important new features are the inclusion of "prognostic information of
systemic biopsy results" ( number of positive and negative cores ) and
entry of the year of surgery, an acknowledgment of progressive improvement
in surgical technique. Alternative versions that did not include the
percentage of cores positive "had less predictive accuracy in external
validation" The data is based on the post surgical outcomes of 1978 men
who were treated by high-volume surgeons at Baylor and MSKCC between 1983
and 2002. This population reflects the significant changes in tumor grade
and the stage migration that have been seen in more recent years as the
findings from PSA screening programs have become the indication for
prostate biopsy. The extension of observations to 10 years is additionally
informative "because a substantial number of men will experience disease
recurrence after maintaining an undetectable PSA level for 5 years or more
after radical prostatectomy", whereas only 3% will relapse after that
period of apparent disease control. As before, disease progression was
"defined as a serum PSA value of 0.4 ng/mL or greater (confirmed by a
second PSA value higher than the first by any amount), secondary therapy,
clinical recurrence, or aborted radical prostatectomy for lymph node
metastases". The final nomogram functioned well when it was validated by
comparison with 1545 patients operated by different surgeons. A unique
feature of the current nomogram allows the option "to estimate the
probability of recurrence at any point in time from 1 to 10 years after
radical prostatectomy". Michael Kattan indicated ( personal communication
) that this new data will shortly be incorporated into their existing
Web-available preoperative nomogram.
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