Thanks to your encouragement to raise the issue with my surgeon, we just talked, and here's his explanation.
He said the problem with using simple protocols that stratify people into low, intermediate, and high risk is that the intermediate category is very broad and so if you use only a three tier system you over-treat some people and under-treat others.
As a result, he said that they (at UCSF) us a system called CAPRA to stage the patients headed for RP. Capra is a 1-10 scoring system. It's similar to the Kattan nomogram but it has two key advantages (1) it's simpler to calculate and interpret, so you don't need a paper form or computer, and (2) it's based on data from patients treated in the community so it's a little more accurate (less optimistic) relative to Kattan for the lowest risk patients treated in the community. It's been well validated, and you can read about
By the CAPRA system, my score is on the low side of 3 (on a scale of 1-10) which puts me in the lowest rung of intermediate cancers, and for this score, the risk of lymph node involvement is only 2.4%. So at that level, and given that there is some morbidity associated with lymph node dissection, their protocol is not to dissect lymph nodes. Whether or not you agree with that decision is a question, but at least I have the satisfaction of knowing that the decision was based on sound science, and not just an oversight in the OR or the path lab.
With the URL above you can go calculate your own scores, or you can use the online calculators at MSKCC. I did it both ways, and the results are quite close.
thanks again for your suggestions and encouragement.
Post Edited (proscapt) : 8/31/2010 5:26:01 PM (GMT-6)