Predicting the development of prostate cancer and future outcomes

Predicting pathological stage using the Johns Hopkins Hospital's Partin tables nomogram

A predictive tool known as a "Partin Tables nomogram" that predicts the severity of prostate cancer and helps clinicians and patients make treatment decisions, is available online through this web page on the John Hopkins Hospital site:
http://tinyurl.com/dme35x The tool uses commonly available preoperative data - serum prostate-specific antigen (PSA) level, clinical stage, and biopsy Gleason score - to predict pathologic stage, which can only be fully assessed once the prostate is surgically removed. The tool is derived from a study of more than 5,600 men treated at Johns Hopkins Hospital from 2006 to 2011. By inputting the PSA, Gleason score, and clinical stage into the tool and clicking the Find Results button, you can obtain an estimate of the probability that the cancer is confined to the prostate, has migrated to the edge of the gland, has invaded the seminal vesicles, or has spread to the lymph nodes. Staging classifications are described clearly in Assoc. Prof. Prem Rashid's book "Prostate cancer - your guide to the disease, treatment options, and outcomes" (3rd edition) published in 2010 by Uronorth Group and available from the PCFA - see http://tinyurl.com/2c7h6ee. On page 66 of that book the TNM system is described and it can be downloaded from our web site here as a 260 KB PDF file. Note that the data that were used to generate the nomogram relate to men treated in the USA, so the applicability to men treated in Australia is unknown.

Memorial Sloan-Kettering Cancer Center nomograms

The
Memorial Sloan-Kettering Sloan Cancer Center has a set of four online nomograms (again generated from men treated in the USA):
  • Pre-Treatment (Diagnosed with Cancer But Not Yet Begun Treatment). This nomogram can be used to predict what will happen after receiving a primary treatment (e.g. radical prostatectomy or brachytherapy).
     
  • Post-Radical Prostatectomy (Recurrence After Surgery). This nomogram can be used to predict the probability that a patient's cancer will recur after radical prostatectomy, that is, the probability at two, five, seven and 10 years that the patient's serum PSA level will become detectable and begin to rise steadily. The nomogram should only be used for patients when radical prostatectomy is the sole, primary treatment.
     
  • Salvage Radiation Therapy (Considering Radiation Therapy After Surgery). This nomogram is designed for men who have experienced a recurrence of their prostate cancer after treatment with radical prostatectomy. The tool predicts the probability the reoccurrence can be successfully treated with salvage radiation therapy (SRT), calculating the probability that the cancer will be controlled and the PSA will be undetectable six years after SRT.
     
  • Hormone Refractory (Progression of Metastatic Prostate Cancer That Can No Longer Be Controlled by Hormones Alone). This nomogram can be used by patients with advanced, metastatic prostate cancer, who have a rising PSA and evidence of progression of their cancer despite maximal treatment with hormone therapy. The nomogram can be used to predict the probability of survival one and two years later based on a man's age, his PSA level, his performance status, and a variety of standard laboratory tests.