Use of nomograms to predict the risk of disease recurrence after definitive local therapy for prostate cancer
Section snippets
The utility of nomograms
Prostate cancer can be seen as a chain of interconnected disease states ranging from diagnosis to death; nomograms can provide useful predictions for each disease state. At diagnosis, a patient faces the daunting task of selecting a treatment that offers the most promising outlook for cure, as well as for QOL. At this stage, nomograms can predict cancer control based on a patient's clinical parameters and the treatment selected. Similarly, for patients who have undergone local definitive
General principles
Several considerations apply when designing nomograms. A nomogram should accurately predict which patients will and will not reach the end point (discrimination), generate predictions that closely approximate actual outcomes (calibration), and perform consistently when applied to different data sets (validation). They should also be based on a sufficient number of cases; specifically, they must incorporate a large enough proportion of cases that reach the end point of interest. Nomograms should
Development considerations
The Memorial Sloan-Kettering Cancer Center (MSKCC) nomograms developed by Kattan et al.19 are based on Cox proportional hazards regression analysis modified by restricted cubic splines.19, 28, 34, 35, 36 Unmodified Cox models require variables to assume linear relations, which is not ideal because it assumes that incremental changes represent the same significance across the spectrum of values. For example, an increase in PSA level from 2 ng/mL to 4 ng/mL would represent the same significance
Nomograms available for patients with prostate cancer
Many nomograms exist for prostate cancer.24 This discussion, however, will be restricted to 4 contemporary models that predict the continuous risk of disease progression after local definitive therapy with RRP,34, 35 EBRT,19 or TPIPB.36 Each of the pretreatment models predicts the 5-year probability of remaining free from disease progression (ie, the progression-free probability), based on PSA relapse after definitive therapy. The postoperative model predicts the 7-year progression-free
Limitations of nomograms
Although clinically useful for counseling patients, nomograms are far from perfect and cannot be applied to all men with prostate cancer. In general, nomograms are constructed19, 20, 21, 34, 35, 36, 44, 46 and validated29, 41, 42 using patients treated at academic centers, whose outcomes may differ considerably from outcomes of patients treated at community health centers, because the quality and availability of treatments can vary with the location and experience level of the treating
Conclusion
Nomograms have proved useful as adjunctive tools for counseling patients with prostate cancer. Although current nomograms are limited in their application and accuracy, efforts are continuously under way to improve them and to develop novel instruments for other end points. The ultimate objective is to construct a suite of nomograms that can predict cancer control and survival, as well as quality-adjusted survival, to help guide the selection of treatments at all stages of prostate cancer. The
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Impact of positive surgical margin on biochemical recurrence following radical prostatectomy in locally advanced prostate cancer
2016, Kaohsiung Journal of Medical SciencesEndocrinology of Benign Prostatic Hyperplasia and Prostate Cancer
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2010, Endocrinology: Adult and Pediatric, Sixth EditionManagement of Prostate Cancer in the Older Man
2008, Seminars in OncologyCitation Excerpt :The use of nomograms can reduce bias by consistently predicting outcomes for individual patients. Pretreatment and post-treatment nomograms have been developed for predicting outcomes from RP, EBRT, and radioactive seed implantation.89 Despite the potential clinical utility of nomograms, these tools were developed and validated at academic centers, which may not reflect the general patient population.