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Prognostic prostate cancer (PC) nomograms, life expectancy predictions, and quality-of-life instruments offer important insights into patient outcomes under different treatment regimens, but these tools are still underutilized at many cancer treatment facilities. Their wider use in clinical settings will improve care and empower patients.
Prostate cancer is common and will affect increasing numbers of men as the Baby Boomer generation ages, but survival rates are good—particularly when tumors are detected at early stages.1 The vast majority of men with a new diagnosis of prostate cancer have localized disease, and for these patients, 5-year survival rates exceed 90%.1
Weighing the benefits external-beam radiotherapy or brachytherapy against watchful waiting, or alternative or additional treatment modalities such as prostatectomy, robotic-assisted surgery, or hormone ablation, is a complex decision-making process. Which regimen is best frequently depends not only on treatment modality but also an array of clinical and pathologic factors including biochemical markers such as PSA score and tumor aggressiveness.1,2 Multivariate prognostic algorithms, called nomograms, are designed to capture these factors and inform clinical decision making. They are predictive tools that can help clinicians with patient risk stratification and selecting treatment options that are most likely to benefit their patients.1
Several prostate cancer nomograms have been developed and validated for clinical use, and new enzymatic and other predictive biochemical markers that might further refine patient risk stratification practices are in development.3-6 Preoperative nomographs typically include factors such as PSA level at diagnosis, clinical stage, and grade (Gleason score).3 Postoperative nomograms include these factors plus surgical margins, capsular and seminal vesicle invasion, and regional lymph node status3 (Table 1).
Table 1. Widely used postoperative prostate cancer nomograms16
| Nomogram | Criteria factors | ||
| DPC (Duke University)10 | Adjuvant radiotherapy Ethnicity Extraprostatic tumor extension Pathologic Gleason sum Preoperative PSA Prostate weight Seminal vesicle invasion Surgical margin status |
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| Kattan (MSKCC/Baylor College of Medicine)11 | Adjuvant radiotherapy Extraprostatic tumor extension Lymph node status Pathologic Gleason sum Preoperative PSA Prostate weight Seminal vesicle invasion Surgical margin status |
||
| JHH (Johns Hopkins University)12 | Adjuvant radiotherapy Extraprostatic tumor extension Lymph node status Pathologic Gleason sum Preoperative PSA Prostate weight Seminal vesicle invasion Surgical margin status |
||
| CaPSURE nomogram (Walter Reed Army Medical Center)4,13 |
Ethnicity Pathologic Gleason sum Pathologic stage Preoperative PSA |
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| Key: CaPSURE, Cancer of the Prostate Strategic Urologic Research Endeavor; JHH, Johns Hopkins Hospital; MSKCC, Memorial Sloan Kettering Cancer Center; PSA, prostate-specific antigen. | |||
Clinical guidelines from the American Urological Association (AUA) and the National Comprehensive Cancer Network (NCCN) recommend incorporating risk stratification, functional outcomes, and life expectancy in treatment decision-making, and that treatment strategies reflect patients’ informed preferences in light of such information.2
Successful treatment and good survival rates mean that quality of life (QOL) outcomes will become an increasingly prominent factor in treatment decisions. Among men whose prostate cancer is diagnosed after tumors have spread to adjacent or distant tissues, and for whom prognosis is not as encouraging, prediction of probable responses to different therapeutic regimens is particularly important.
