Yes I was also impressed by the nomogram and also by speaking to Dr Cohen. His findings are that the % of Gleason 4/5 and positive margins have the biggest impact on the outcome.
The % of Gleason 4/5 that he is referring to is the % out of the total prostate cancer that is Gleason 4/5. So in your example this would be 60%. I know this for a fact because I went to him for a second opinion on Paul's pathology, post RP. His view was that Pauls PC was 30% Gleason 4/5 as opposed to the first pathologist who said it was only 5% Gleason 4/5. He said this did make a difference, increasing the likelihood by a couple of % points of a recurrance. Paul's chances of a recurrance are about 4.5% according to Dr Cohon's nomogram using 30% Gleason 4/5 and 2.5% using 5% Gleason 4/5. A small but significant difference.
Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)
Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4 (ISUP 2005). Neg (margins, seminal vesicles, extraprostatic extension). Multifocal, with main involvement in the fibro-muscular zone. T2C.
Post RP PSA,
Lab 1: Sep10 – 0.02|Nov10 – 0.03|Dec10 – 0.03|Feb10 – 0.03
Lab 2: Nov 10 - 0.01|Dec10 – 0.01|Feb10 – 0.01