Who has a reliable nomogram?

When I go thru online nomograms I seem to find vast variations in possible outcome probabilities. For example, the Sloan nomogram seems to have the most optimistic outcomes while the nomogram the VA uses seems to have more dire outcomes.

"A nomogram, graphical calculating device designed to allow the approximate graphical computation of a function.."

I would use the Slone K. nomograms. My guess is that the VA nomograms use selective data, ie Veterans that are most likely to be older. Also their treatments may no be as effective as MSKs, hence worse outcomes.
The SK nomograms are highly accurate in that they use a very large base of patients. You must remember that they reflect statistical probabilities and can not predict individual results.
They are valuable in predicting which treatment has the best probability of working given the data that is input, not that the actual treatment will in fact work. There are just too many variables when dealing with PC, not to mention that the data that is input may not be accurate, ie gleason and %of cores.
JT

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64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.

As of April 10 and 7 weeks on Casodex and Proscar PSA has gone from 30 to 0.62 and protate from 60mm to 32mm. Very minor side affects. Doc says all this indicates tumor is not aggessive

Awaiting schedule for seed impants

 

Well said John T. I totally agree with your opinion.

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Age 51yrs

I'll second (third?) the above. Nomograms are an attempt to induce a formula for some clinical outcome (PSA rising, metastasis, probability of dying of PC, etc.) from some set of statistical data. Each one correctly portrays the results a particular research team found, but the results will vary for the reasons stated above (one institution's effectiveness, different age of patients, small sample, etc.)

You can get closer to the underlying data at the American Cancer Society's website
/www.cancer.nexcura.com/Secure/InterfaceSecure.asp?CB=265 so you can sort of pick and choose which study matches your conditions. In some cases they try to do the work for you.

But it all comes down to the problem that your odds of whatever are either zero or one, but you'll never know until after the fact.

Good luck.

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Larry Shick
Personal homepage incl. PCa story: www.sv-moira.com.
01/09: Diagnosed (age 60) biopsy PSA 4.4, free PSA 9%, T2c stage, Gleason 7 (3+4), 7 of 14 cores; 6'2", 200 lbs.
03/09: Robotic surgery (Dr. Kawachi, City of Hope) 47 gms, 10% involved, staging/Gleason unchanged (pT2cNXMX), margins clear, no ECE/sem ves involvement, fully continent from day 1, some success w/Viagra 50mg/day.
Followup: 05/09 0.006

I think nomograms are a good thing and I believe that the statistical manipulation behind the sloan-kettring ones is very solid. On the other hand, if you are going to have 10 year survival rates then you need to be using data from people treated in 1999 and (mostly) before – actually the cut-off is more like 1997 since it takes several years to process the data. Has the detection and treatment of PC changed over the last 12 years? You bet! – and all of us are glad for it! Of course the researchers who build the nomograms know this and have techniques for using five and even three year survival data to “tweak” their models.

Another point in modeling is that the researchers set very high standards for “proof” that certain measures are associated with certain outcomes. You may have noticed that many members here provide greater detail in their sigs than can be entered into the nomogram. Largely this is because when you get too few patients with a certain set of stats you just don’t meet the standards for certainty that the researchers require. So your case may be different in ways that make things better or worse, but just not sufficiently predictable.

Finally, probabilities don’t tell what will happen to you. Some people get a seven on the first roll of the dice and others come up snake eyes. Here is wishing for sevens for each of you.

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Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3 + 4 = 7
CAT scan 1/09 negative, Bone scan 1/09 negative

Robotic surgery 03/03/09 Catheter Removed 03/08/09
Post surgical pathology report. Lymph nodes negative, Seminal vesicles negative
Surgical margins positive, Capsular penetration extensive Gleason 4 + 3 = 7
At 6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.