Dealing with a diagnosis of prostate cancer is difficult enough, but having to select from a host of treatment choices, each with its own relative advantages and disadvantages, can be bewildering. To help men with this dilemma, physicians and statisticians from Memorial Sloan-Kettering Cancer Center, along with colleagues from the Cleveland Clinic, have created a newly revised and expanded prediction tool to help patients with prostate cancer decide which treatment approach will provide them with the greatest benefit.
The updated tool, called a nomogram, is a computerized statistical program that uses clinical data to enable patients and doctors to more accurately predict a patient's outcome, thereby helping them to choose the best treatment plan. The prostate nomogram cannot definitively answer the complicated question of which treatment is most appropriate for an individual patient. It simply provides information that may be useful for the decision-making process, which should be carried out in consultation with a physician.
The new prostate nomogram is divided into three main tools -- Pre-Treatment, Post-Radical Prostatectomy, and Hormone Refractory -- and includes survival statistics up to ten years following treatment.
Tool for Those Who Have Not Been Treated
The Pre-Treatment tool is designed for prostate patients who have received a biopsy confirming the presence of cancer but who have not yet received any primary treatments. Primary treatments can include the surgical removal of the entire prostate gland (radical prostatectomy), a form of radiation therapy using radioactive seeds implanted inside the prostate (brachytherapy), and external beam radiation therapy. Using clinical data such as PSA value, Gleason grade, clinical stage, and the number of positive and negative biopsy samples, the Pre-Treatment tool can be used to predict a patient's probability of survival. Specifically, the tool predicts the likelihood that a man's prostate cancer will not progress, or grow, at five, eight, and ten years after receiving radical prostatectomy, external beam radiation therapy, or brachytherapy.
Tools for Patients Who Have Been Treated or Who Are Receiving Treatment
The Post-Radical Prostatectomy tool can be used for patients who have already received a radical prostatectomy as their primary treatment. Using PSA value, Gleason grade, and information on surgical margins and seminal vesicle and lymph node involvement, as well as other clinical data, this tool calculates the probability of avoiding disease progression -- meaning the likelihood that a man's prostate cancer will not have grown -- at two, five, and seven years after surgery. Unlike other predictive models, this tool's predictions can be adjusted for the disease-free interval that a patient experiences after radical prostatectomy.
Introduced in this new version of the nomogram, the Hormone Refractory tool is designed to be used by men who already have been treated either with prostatectomy or radiation therapy as a primary treatment and who are considering hormone refractory treatment. (A patient whose prostate cancer has spread beyond the prostate or has recurred after treatment often considers hormone therapy, which is used to reduce the levels of testosterone, as testosterone can stimulate the growth of prostate cancer cells.) Using clinical data such as PSA value, hemoglobin value, and a test result known as Karnofsky Performance Status, the Hormone Refractory tool predicts survival probability at one and two years after hormone therapy.
