Are the MSKC nomographs too "optimistic"?

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Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 6/9/2010 10:34 AM (GMT -6)   
compiler said...
Well, the nomographs are still quite valuable. It is important to know some probabilities when making treatment decisions.
I realize that I am only a sample size of ONE, but that's the best I can do.
 
However, having said all of that, my problem with the nomographs concern accuracy. Basically, according to the MSKC nomograph, my odds look great, even with my relatively poor pathology. I sure HOPE those probabilities are accurate, but I find it hard to believe. I just think they are too optimistic. That's just my gut feeling. Yet MSK certainly has a stellar reputation.
compiler,
 
I too have noticed and been concerned about the apparent "optimism" of the MSKC nomographs.  Personally, I tend to average the MSKC results with the less optimistic Johns Hopkins results in trying to get a handle on my risks.  One of the problems I have with the latter is that it fails to take into account the well-documented fact that the longer you stay at the undetected PSA level post-op, the better.
 
Another tool I find interesting is Scardino et al's clever multi-factor graph.  Although he is now in NYC, he prepared the first version of this graph while he was here in Houston at Baylor.  In any event, at least in my case, his results are very close to the MSKC nomograph results - probably not surprisingly but arguably at least somewhat comforting!
 
As a mathematics guru, I would very much appreciate any additional thoughts you may have.  Thanks.
 
And to save Purge the trouble, I'll put this in all caps: EVERY CASE OF CANCER IS UNIQUE.
 
Zen9 

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/9/2010 10:40 AM (GMT -6)   
gee, zen, is some of your harmless sarcasim starting to turn to something else. your post above was good, i agree with most all you posted. like all stats, they have a relative value, and should only be used as a tool to get some comparative value.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Zen9
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Date Joined Oct 2009
Total Posts : 314
   Posted 6/9/2010 10:46 AM (GMT -6)   

Purge,

PLEASE don't highjack this thread.  It's meant to be a serious question to compiler and anyone else who wants to chime in.

You and I do not always see eye-to-eye, but I have immense respect for you.  Period.

Zen9


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/9/2010 10:55 AM (GMT -6)   
Then Zen, why did you provoke me by adding the very last line of your post, there was no reason to do that. Your post on its own merit was great, and I, myself, and many others would be interested in. You should be able to see what I mean, as you wrote it.

In reality, I have a feeling we agree way more then we would disagree, we just communicate somewhat differently, and thats cool.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 6/9/2010 11:05 AM (GMT -6)   
The nomograms are a set of tools used to predict outcomes based on the historical outcomes of others by inputting a bunch of independent variables to statistically predict a dependent variable.  
 
It will NOT tell you that because you have this PSA, and this Gleason, and this exact result for the other inputted independent variables, then you MUST have this outcome. 
 
But, it will tell you that on average, men will have the nomogram-predicted outcome.  When using averages, one must recognize that some will have higher results, and others will have lower results...or, to the zen/Purg comment, "EVERY CASE OF CANCER IS UNIQUE."
 
You should accept the understanding of how to use averages before using any nomogram.
 
Differences between one organization's nomogram results and another's are simply because their base of data is different.  With enough data for both, there are diminishing differences.
 
The other thing to keep in mind is that the sampling of men who regularly participate on help-seeking sites like this is not necessarily representative of the total population of men with PC—don't use this group to guage in your mind against the nomogram-predicted averages.  Some men hang around to continue offering help to others, but many of the participants here have on-going issues they are seeking help/experiences from others on.  In other words, there are many men who have had no issues and have simply moved on with life, never seeking out help-sites like this, or never coming back because they've had no issues.
 
 
 
 
 
.

Post Edited (Casey59) : 6/9/2010 10:15:20 AM (GMT-6)


Carlos
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Date Joined Nov 2009
Total Posts : 486
   Posted 6/9/2010 11:12 AM (GMT -6)   
Zen,  Thanks for asking the question.  I also get a very optimistic forecast.   I looked up the abstract from the MSK study and copied the following from it:  "The concordance index of the nomogram when applied to the independent validation sets was 0.81 and 0.79. CONCLUSION: We have developed and validated as a robust predictive model an enhanced postoperative nomogram for prostate cancer recurrence after RP. Unique to predictive models, the nomogram predictions can be adjusted for the disease-free interval that a patient has achieved after RP".    I also looked at an abstract of a study that studied nomogram predictions.  They concluded that most were poorly done and only a small percentage used proper independent validation such as the MSK study.   Here is a link to the MSK abstact if interested:  http://www.ncbi.nlm.nih.gov/pubmed/16192588?dopt=Citation.  Hopefully someone with more info can step in.
 
Carlos

Diagnosed 2/2008 at age 71, Gleason score 5+3=8, stage T1c, PSA 9.1. 
Robotic surgery 5/2008, nerves spared, stg. pT2c, N0, MX, R0, Gleason 5+3=8 
PSA <0.1 at 20 months and each test since surgery.


English Alf
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Date Joined Oct 2009
Total Posts : 2218
   Posted 6/9/2010 11:16 AM (GMT -6)   
The nomograms just tell you what chance you have of being in "Group A = the guys who will be okay" or "Group B = the guys who won't be okay", it does not tell you which group you are actually in, or will end up in.

And I don't know about them optimistic either. I fed in my stats when I started RT and it reckoned that I've only got a 26% chance of having no recurrence in 5 years time.

I guess it depends on what your stats are as to what is getting predicted. (I have also tried deliberately putting in some different numbers to see how the outcome changes depending on which stat is higher or lower.)

Alfred
Age at Dx 48 No Family history of Prostate Cancer
Married 25 years, and I cannot thank my wife enough for her support.
April 2009: PSA 8.6 DRE: negative. Tumour in 2 out of 12 cores. Gleason 3+3.
RALP (nerve-sparing) at AVL-NKI Hospital Amsterdam on 29th July 2009. Stay 1 night.
Partial erections on while catheter still in. Catheter out on 6th Aug 2009.
Dry at night after catheter came out
Post-op Gleason 3+4. Tumour mainly in left near neck of bladder.
Left Seminal Vesicle invaded, (=T3b!)
no perineraul invasion, no vascular invasion. clear margins,
Erection 100% on 15th Aug 2009, but lots of leaking of urine
Stopped wearing pads on 21st Sept 2009
Pre-op style intercourse on 24th Oct 2009 !! No use of tablets, jabs, VED etc. but...
Nov 17th 2009 PSA = 0.1
Can still get erections okay, and almost no leaking of urine, but since December 2009 I don't have orgasms, instead I just have intense pain in place where prostate used to be.
Mar 17th 2010 PSA = 0.4!!! referred to radiation therapist
April 13th 2010 CT scan.
April 28th 2010 Started Radiation Therapy (66Gy - 33 sessions)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/9/2010 11:18 AM (GMT -6)   
Casey, you are right on target. I think there are folks that don't understand how "averages" are actually used. And all nomograms are calculating tools. I re-checked mine, just this morning, and did all of them. Before primary treatment, after primary treatment, and post-SRT, so far, they have all been wrong for my reality. But that is what averages are all about. You have a high, a low, and a lot in between, and where you fall in place, is based in your own numbers.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 6/9/2010 11:23 AM (GMT -6)   
Carlos said...
...I also looked at an abstract of a study that studied nomogram predictions.  They concluded that most were poorly done and only a small percentage used proper independent validation such as the MSK study.   Here is a link to the MSK abstact if interested:  http://www.ncbi.nlm.nih.gov/pubmed/16192588?dopt=Citation.  Hopefully someone with more info can step in.
 
Hi Carlos,
 
I've also seen this report abstract you linked to, but I draw a very different (in fact, opposite) conclusion than you.  I'm a little baffled by your comment.
 
The report says:  "A postoperative nomogram for prostate cancer recurrence after radical prostatectomy (RP) has been independently validated as accurate and discriminating."   [I added underlining for emphasis.]
 
It goes on in the conclusion to state that after validating with two cohort study groups of 1,782 and 1,357 patients, respectively, that "We have developed and validated as a robust predictive model an enhanced postoperative nomogram for prostate cancer recurrence after RP."
 
Were you reading another report...?
 
 
 
 

Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 6/9/2010 11:47 AM (GMT -6)   
Casey,  This is the other study I mentioned:  "Reporting performance of prognostic models in cancer: a review"  at this link - http://www.ncbi.nlm.nih.gov/pubmed/20353579.  Hope this helps.  I worked with statistics most of my career and this is about all that I remember.  Statistics are just numbers and are meaningless on an individual basis.  I either will or will not have a recurrence.  There is simply no way to predict the future.  I have quoted Yogi Berra before, "Making predictions is very difficult, especially about the future".
 
Carlos

Diagnosed 2/2008 at age 71, Gleason score 5+3=8, stage T1c, PSA 9.1. 
Robotic surgery 5/2008, nerves spared, stg. pT2c, N0, MX, R0, Gleason 5+3=8 
PSA <0.1 at 20 months and each test since surgery.


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/9/2010 3:25 PM (GMT -6)   
Carlos said...
Casey,  This is the other study I mentioned:  "Reporting performance of prognostic models in cancer: a review"  at this link - http://www.ncbi.nlm.nih.gov/pubmed/20353579.  Hope this helps.  I worked with statistics most of my career and this is about all that I remember.  Statistics are just numbers and are meaningless on an individual basis.  I either will or will not have a recurrence.  There is simply no way to predict the future.  I have quoted Yogi Berra before, "Making predictions is very difficult, especially about the future".
 
Carlos

 
OK, Carlos, thanks for sending this additional link.  I had not seen this report.  I think we are on the "same page" now (I think I misread your earlier posting...sorry). 
 
But, so as to not confuse anyone else, this study said that some of the 47 models it studied (via literature scan) were not very good, but the nomograms like MSKC that use solid statistical methods & verification are good.  (referencing your original link with the MSKC verivication)  No real surprise here, since any newly developed models would be published in the literature early in their development and included in their pool of 47.
 
And in the 2nd half of your paragraph, above, again I think we are saying the same...the way I said it was "You should accept the understanding of how to use averages before using any nomogram."
 
best regards...

Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 6/9/2010 4:00 PM (GMT -6)   

By the way, here's the link to the graph by Scardino et al. I referred to earlier.  It's Figure 2 in this 2005 article.

http://jco.ascopubs.org/cgi/reprint/23/28/7005.pdf

In my case at least one gets a very similar result as with the MSKC nomogram.

Zen9


BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 6/9/2010 5:10 PM (GMT -6)   
Zen was kind enough to llst that Sloan-Kettering link yesterday in reponse to my question about life expectancy tools. Obviously it can only provide information about averages.. and obviously it is only as good as the raw data used to calculate those averages... with a side order of perhaps improvement in treatments as time passes. I dealt craps (dice) for several years in Vegas, so I can appreciate "averages'... which are obviously NOT guarantees. To look at the longer term results of those similarly situated is about all we can hope for in evaluating future liklihood. All that said, AM I READING THAT Nomograph correctly? I listed a pre PSA of 4, 51 years old, a 4+3=7 post RP Gleason, T3a stage, year of RP = 2010, I told it 3 mo cancer free, and then stated YES to all 4 of the pathology questions (even though I dont know that to be true as of yet)... I did not answer Yes to Hormones or prior radiation. It then came back and gave me the "Probability of Prostate Cancer Mortality After Surgery of 1% for both 10 years and 15 years". So is it suggesting that a person in the condition I gave them has a 99% chance of not dying from prostate cancer in 15 years? Without even accounting for the type of treatment they may receive? (Sure hoping it's not a 1% chance and i'm reading it wrong)....Thanks.
First ever PSA test Jan 2010 @ 51 years old. 4.0.
Digital exam in March 2010 showed 1 side hard, other soft.
Biopsy, positive in 3 of 12.
Davinci @ Boston Medical Center, May 17, 2010.
Was suggested prior to it was likely contained.
June 1 advised 3+-4 was really 4+3 per pathology. Pos margins.
Catheter removed June 1.. 1 pad/day, doing ok. ED, but not in rush.
Sore as heck down there, but doing much walking with my wife.
To meet with my Uri (1st meeting since) June 17 - 1 mo point, to discuss.
BMC already has me setup to meet with radiology.
Felling a little better each day. Cant tell if my expectancy just went from 10-15 down to 5-7, the information out there appears to be all over the place. I WILL NOT radiate my insides to the point of being a veg for the sake of a few years. QOL is primary to me. Selfish I guess. I pray for all of you as I do for myself, but must remember that i've had a pretty good 50+ years, and know others who have lost their children to disease.. so I dont have the nerve to complain!


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 6/9/2010 5:53 PM (GMT -6)   

BobCape,

Playing Devil's Advocate, I could point out, e.g., that there can be many years between biochemical recurrence and PC-specific death, especially these days.  

But even considering this and other potential explanations, you have put your finger on exactly why I started this thread.
 
By the way, I posted the link to Scardino's graph earlier this afternoon.  If you want, run your numbers on Figure 2 and see what you think of the results.
 
Zen9
  

Post Edited (Zen9) : 6/9/2010 5:00:19 PM (GMT-6)


tatt2man
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Date Joined Jan 2010
Total Posts : 2845
   Posted 6/9/2010 7:16 PM (GMT -6)   
I feel it is a sad measure when being "optimistic" is a bad thing.
I am not approaching this disease blindly or as a fool as I have often been made to feel by posters here at HW with strong opinions on this disease.
I agree that accuracy helps determine the optimum course of action by the patient and the doctor(s).
I will view the above mentioned links and graphs and see how they differ with my stats...
But regardless of the outcome, I will remain optimistic.

sincere hugs,
BRONSON
.................
Age: 54 - gay - with common-law spouse of 13 years, Steve - 60
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis - girth back to normal -but not much length - will go for trimix in April when I see doc
Incontinence: Feb 2010- 3-5 pads/1-2 clothes changes/day- March 3, 2010 - week 14 after surgery -finally seeing improvement - March 29- incontinence better - 1-2 pads a day - one pad at night - May 25 - 1 pad during day - 1 pad at night for security (barely needed at all) - stress incontinence at work - lifting trees and shrubs...
location: Peteborough, Ontario, Canada
Post Surgery-PSA: - April 8, 2010 - 0.05 - I am in the ZERO CLUB - hooorah!
Next PSA - October 8, 2010 - TBA -
............


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/9/2010 7:50 PM (GMT -6)   
And so you should, Bronson.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 6/9/2010 8:24 PM (GMT -6)   
BobCape said...
...It then came back and gave me the "Probability of Prostate Cancer Mortality After Surgery of 1% for both 10 years and 15 years". So is it suggesting that a person in the condition I gave them has a 99% chance of not dying from prostate cancer in 15 years?
Yes, that's exactly what it means.
 
You have a 1% chance of dying of prostate cancer in both 10 and 15 years, even though you entered "yes" to all the pathology questions (seminal vestical involvement AND lymph node involvement).
 
Simply stated, you don't have the type of most common case characteristics of a man that dies of PC.  In other words, it is rare for someone with Gleason=7 (or even Gleason=8) to die from PC.  [This is why I posted in another thread about a week ago that death by PC is predominantly, but not exclusively, a poor man's outcome...poor men don't have insurance, the don't have PSA tests, then they show up in the emergency room peeing blood at age 65 and find their PSA is 90 ng/mL, and later find their Gleason is 5+5, and they have no insurance to pay for treatments.]  This would be another appropriate time to repeat the zen/Purg comment from earlier, "EVERY CASE OF CANCER IS UNIQUE", and "predominantly" does not mean "exclusively."  There are a lot of men who fit this model, but they aren't posting here.  There are also men who also take better care of themselves who also die from PC, but they are a very small percentage of the total PC deaths typically with uniquely aggressive strains.
 
If you've got some math skills, you can actually see the sensitivity to the input variables in graph (the pdf link) that Zen9 posted earlier today...or just play with the numbers in the computer nomogram. 

North Alabama
New Member


Date Joined Jan 2010
Total Posts : 18
   Posted 6/9/2010 8:50 PM (GMT -6)   
Has anybody used this one ? It gives a little less favorable outcomes.

http://www.nomogram.org/

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 6/9/2010 9:05 PM (GMT -6)   
My stat prof once said that "on the average everyone has one tit and one ball". Nomograms represent the averages and are just one tool used to evaluate the extent of PC. As Strum said, MD stand for Medical Dectective and you have to use a lot of clues about your individual PC in order to come close to the truth. PAP, Ploidy analysis, scans along with nomograms and neural networks are all pieces to a puzzle.
Nomograms are a valid way to evaluate risk and evaluate what treatment choices will give you the best chance, not to be used in a vacume.
Casey, I agree with what you are saying about people dying from pc. The stat that I could never get by is the fact that about 50% of all men over 50 have some sort of PC and that percentage grows as you age. PC deaths account for only 2% of total deaths to men, therefore only 4% of those having pc actually die from it.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


North Alabama
New Member


Date Joined Jan 2010
Total Posts : 18
   Posted 6/9/2010 9:06 PM (GMT -6)   
Here is another one, even less favorable. It says it uses artificial intelligence. I think that the MSKC results have been verified and use the most reliable database.


http://www.prostatecalculator.org/

Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 6/9/2010 9:30 PM (GMT -6)   
I am grateful for everyone's response. I have learned something from everyone. If someone is teaching me something, I don't much care what tone he uses because I live to learn. I guess that's one of my many character faults.

I would still like to hear from compiler, who I understand is a math professor at one of this country's finest universities. But we obviously have other very knowledgeable people who have given of their time and skills, and I appreciate it.

At the risk of being greedy, I would love to hear from someone (or multiple people) who can analyze Scardino's eight page article (including his Figure 2) and give us his/her thoughts. For convenience I will repeat the link:

http://jco.ascopubs.org/cgi/reprint/23/28/7005.pdf

Thank you all.

Zen9

rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1132
   Posted 6/9/2010 9:43 PM (GMT -6)   
Zen, a good post. It was interesting plugging in the #'s in the other spread sheets and seeing the results.
 
Age 48 at diagnosis
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
Robotic Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8, clear margins
22 month  PSA <.04
continent at 10 weeks (no pads!)
ED is still an issue


Burlcodad
Regular Member


Date Joined Nov 2009
Total Posts : 254
   Posted 6/9/2010 9:58 PM (GMT -6)   
I agree with you Bronson.  If you've done your homework and made what you feel is the best treatment choice, what happens after treatment is out of your hands.  So why not feel optimistic and hope for the best.  If you can't control your outcome, what does it matter if the statistics say 65% , 80% or 95%.  In my opinion, it's not worth the stress, anxiety or causing hard feelings.  What makes this place great is that we are all in this together- let's not loose sight of that. Just my thoughts.
 
Ray
 
 
Diagnosed 9/09 at age 54  
PSA 6/09 1.3 
Stage 2b (biopsy done because of firmness felt on right side) 3 positive cores out of 12 (all less than 25%) Gleason 6
 
Surgery  1/13/10 at UP- Penn Presbyterian - Dr David Lee. Home 1/14/10 Nerves spared on both sides -Catheter removed 1/19/10  Path report scheduled for 2/11/10
 
Post OP Pathology Report Gleason score was upgraded to 7 (3+4)
no capsular involvement, seminal vesicles clear, lymph nodes clear, negative margins, gland involvement 2-10%
 
Since report was good and recovery going well next appt is now  the first psa test appt scheduled for 4/22
 
POST OP PSA   4/10 <0.1,
 
Incontinence - Initial 6 pads a day, 3 Weeks - 3 pads a day relatively dry at night , 3 Months mostly dry 0-1 pad per day
 
ED - yes but seeing some improvements - levitra 10 mg 2x week 3 months  100 mg almost daily
 
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/9/2010 10:08 PM (GMT -6)   
Ray, yours is a very good opinion to have on the subject. Good answer.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 6/10/2010 12:45 AM (GMT -6)   
Howdy all.
 
Sorry, I don't have much time to post. I am in KC, grading AP Calculus tests. We will be doing this through next week.
 
Connectivity a tad limited in this hotel.
 
I think the Scardino article certainly mirrors the MSK nomograph.
 
I'll try and participate more when I'm back home.
 
Of course, I have a PSA test when I get  home...sigh....
 
Mel

63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3 was about 75 (way above the 35 threshold). That led to:

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms.  (Second opinion from Jon Epstein at Hopkins confirmed these results)

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent! Uh...OH. As of about 3/16/10 problems with constant urgency although no pads needed--feels like an infection but none showing in urine.

Update: since late March all is well in that area. I would say 99.9% continent (a spurt here and there, maybe 5 spurts per week).

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in mid-June.

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