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woodstock97
Regular Member


Date Joined Apr 2008
Total Posts : 44
   Posted 4/23/2011 3:46 PM (GMT -6)   
Why is it that the nomograms have such a wide % difference of BCR post surgery? The 3 I am referring to are Sloan Kettering (which we all know) prostatecalculator.org and nomogram.org. Sloan's is so optomistic it is scary compared to the others... By the way, does anyone know of any other nomograms out ther to use?????

proscapt
Veteran Member


Date Joined Aug 2010
Total Posts : 644
   Posted 4/23/2011 4:58 PM (GMT -6)   
Well, there are many potential issues.

One reason is that they don't all look at all the same data.

For example, looking at this nomogram.org calculator of local recurrance after surgery

nomogram.org/Prostate/pros_calc.php

It assumes that a Gleason 4+3 is the same as a Gleason 3+4 which other evidence shows is not really the case. So it will be over-optimistic for one and overly pessimistic for the other.

Second, in comparing nomograms be careful that the end-state of the two is the same. If one of them predicts cancer specific mortality and the other predicts biochemical recurrence, the answers they generate will be *very* different. Make sure the time periods are the same.

Third, the SMK nomos assume patients are treated at a first rate major cancer center by an experienced surgeon, and some of the others may be based on what happens for average people in a community seeing doctors with a wide range of experience and skill

4th, the studies may have different degrees of ability to follow up over the long term, so data can get lost.

5th, the studies may have different entry criteria which may lead some of them to have patients with more aggressive cancers, or older patients with greater likelihood of dying of something else first.

In any case, after allowing for these kids of differences the nomogram.org calculator for post surgery outcome and the SMK calculator for the same gave me similar results in my particular case. So the agreement or lack thereoff may not be evenly distributed.

Post Edited (proscapt) : 4/23/2011 4:04:03 PM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/23/2011 5:12 PM (GMT -6)   
Good answer, Pro. I find nonograms of limited value. One thing I have learned over the years, dealing with cancer a total of 4 times now, is that a cancer journey is unique down to the individual patient. We have seen that time after time here at HW.

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 4/24/2011 8:26 AM (GMT -6)   
No doubt cancers are unique and trying to quantitify with accuracy is super difficult. The nomogram and Partin tables are an averages thing, maybe like a bell curve. You don't know if you are the lucky guy or no luck guy, individually that is. Hey, your doc doesn't know either...best guess assessment...some docs do not even look at nomograms or Partin Tables, I remember one patient asking his doc about Partin Tables and he said 'what is that???'


Post Edited (zufus) : 4/24/2011 7:44:55 AM (GMT-6)


reachout
Veteran Member


Date Joined May 2009
Total Posts : 739
   Posted 4/24/2011 9:14 AM (GMT -6)   
I don't think your average surgeon has more knowledge of nomograms than a well-informed patient. I have more trust in oncologists who have to be conscious of the odds for various treatments. I realize many surgeons do have knowledge, and have been involved in making them but one urologist I saw read the nomogram wrong. Wasn't until I got home that I realized it.
Age: 66
PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Continent right away, ED
Viagra, Cialis did't work, Trimix works well
Post-surgery PSA:
3, month: undetectable <.1; 6 month: undetectable <.014 (ultrasensitive); 9, 12, 15 month: undetectable <.1; 18 month detectable .05

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/24/2011 10:20 AM (GMT -6)   
zufus, you said, "some docs do not even look at nomograms or Partin Tables"

I am sure that is quite true. My doc knows the different ones quite well, but from the day I met him, he believes that every cancer case is different, and runs a unique course of its own, patient by patient.

So far, my own case has made mockery of all the nomograms I ever looked at, except for the one that An started on a seperate thread. Plugging my numbers into that one, showed that I only had a 1 in 3 chance of not having recurrance in 3 years, mine was in 9 months.

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10
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