How accurate are the MSK nomograms?

I put in 3+4, psa 4.0, T1C, with 2 cores cancerous pretreatment for RRP. The results were 99% cancer specif survival at 15 year mark. Frankly I don't believe it. The historic model says organ confined disease at 63% and 85% progression free after 5 years. Gleason 8 with T2B and psa of 6 reports 10 year progression free at 81%, but the historical model reports 68% at the 5 year mark. The results seem rather optimistic in my opinion. Thoughts?

Glad you mentioned this.......... My post surgery results from Sloan's nomogram indicate 99 % chance of no BCR at 2, 5 ,7 years and 98% at 10 years... My post surgery stats were gleason 6 with positive margin.... PSA before surgery was 3.0 and my age 57. I have been undectectable for 27 months

Any other nomogram or literature you read, doesn't even come close to 98% for 10 years... I am a very positive thinking person, but am amazed at hoe they get there numbers so high......FOR ANYONE NOT HAVING PSA DETECTABLE SEVERAL YEARS OUT.... Any comments are welcome to clear this up for me and SQUIRM

Never had looked at those, guess now I know why - from the MSK page I got a 32% chance of cancer-free at 6 years. Nothing that gives me a warm, fuzzy feeling.

In another thread I reported that my uro's opinion was that with the ultra sensitive test he believed that he was catching BCR much earlier than the tables would suggest. He said that in his practice two years of undetectable was a very good record indeed.

When I run my numbers through MSK, it's shocking really that I had BCR in less than a year after surgery. According to their charts, I should have been progression free for more than 10 years with ease. Kind of scary.

Also, when I run the numbers after taking SRT, the nomogram gives me exactly twice the chances of it working, then did any of the radiation doctors I met with. I find that strange too.

Mel, I get really tired of that line. You, like many other "assumers", don't have a clue about my doctors, their experience levels, or their standard of care with me. Yeah, let's just blame the doctors. I say da*n the Prostate Cancer.

Some recent data confirms the generally favorable picture for many that is implied by the MSK nomograms:

"Based on these data, they have developed a nomogram that is capable of predicting 15-year Prostate Cancer Specific Mortality (PCSM) which was accurate and highly discriminating when tested in the validation cohort of patients.

When patients are stratified by age at diagnosis, the nomogram predicts 15-year PCSM rates as follows:

* For men with a pathological Gleason score 6 or less — 0.2 to 1.2 percent
* For men with a pathological Gleason score of 3 + 4 = 7 — 4.2 to 6.5 percent
* For men with a pathological Gleason score of 4 + 3 = 7 — 6.6 to 11.0 percent
* For men with a pathological Gleason score of between 8 and 10 — 26.0 to 37 percent.
* For men with organ-confined disease — 0.8 to 1.5 percent
* For men with extraprostatic extension — 2.9 to 10.0 percent
* For men with seminal vesicle invasion — 15.0 to 27.0 percent
* For men with lymph node metastasis — 22.0 to 30.0 percent"

This data is for survival after RP for patients treated by experienced surgeons in major cancer centers. For details see: prostatecancerinfolink.net/2011/01/21/projection-of-15-year-prostate-cancer-specific-survival-after-radical-prostatectomy/

In reading the background information behind the nomograms, it is patient data collected over many years that is the fuel behind the calculations. The previous post is correct, each person is an individual but one key point is missing. However, it is somewhat demeaning to suggest to the researchers and patients who provided the data that the nomograms are akin to fortune telling and horoscopes. Real people made up the substance behind those models and proven math went into the calculations. Real people who lived and some who died provided the data. However, regarding the individual outcomes, the reason the nomogram does not provide 100 percent certainty, is due to prostate cancer having a few variations that can be played that are still not explainable or predictable, but they are small variations.

The nomograms answer the same question that you might pose to your doctor. "Given what you see in my biopsy or pathology, what are my chances of being disease free or have a chance for recurrence? If your doctor only had data on a few hundred patients he or she treated, they could look up how others with the same level of disease progressed over time who were patients before you. But that would be a limited set of statistical data points. The SK nomogram takes advantage of obtaining data from thousands of patients treated over many years.

Fortunately, or unfortunately, prostate cancer progression or cessation has a predictable outcome. The nomograms have collected that data in the background and used it to make an algorithm that puts your stats within the bell curve of probable outcomes plus or minus an error factor. Simply, it answers the question, where do I stack up in relation to my peers who HAD the same quantifiable data (Gleason, PSA, staging, etc, age, years since surgery) Remember, the model is based on past performance of many cases statistically modeled.

Why the rosy newer numbers? Following the papers that have been written in the last few years, since it takes so long for prostate cancer treatment to be assured of being effective or in some cases ineffective, it has take a long time to collect meaningful data. Add to that the latest papers on prostate cancer are reaping the benefits of data from the post PSA test era. Life in the PSA era has made a huge difference in the outcomes of patients. Both the Sloan Kettering nomograms for predictive outcomes post surgery as well as the Partin tables predicting pre surgical potential outcomes have been revised several time to reflect newer, better data that has been collected. So it is easy to see why the historical data with lots of pre PSA era patients differs from the new data that reflects people being treated much earlier with lower grade disease.

See this website:
http://prostatecancerinfolink.net/2011/01/21/projection-of-15-year-prostate-cancer-specific-survival-after-radical-prostatectomy/

This paper was posted by Chris R recently in a post called "15 year results of Radical Prostatectomy. A rather large study" here on HW. I don't believe this data has been incorporated into the nomogram yet. It is another post PSA era study into outcomes after treatment that dovetail what is being seen in the SK nomograms based on the data SK collected to date.

So it is up to you to believe or dispute the SK nomogram findings. However, read the background papers that the researchers at SK have written before embracing or dismissing the value of the nomograms. Hope that helps.

Mike S.

If those nomograms were true, there would only be about 6 guys on this (and many other) boards..

The big cancer treatment centers crank this stuff out as a tool for attracting more patients.. "I'm going to MSK because the people they treat do SO MUCH better than "average"..."

That makes my BS bell ring....Nomograms = sales tool.

As always, just my opinion...

Fairwind:

Be careful. Your answer makes little sense. First of all, MSK has loads of data and the nomograph is based on that data. There is an adage, GIGO (Garbage In Garbage Out). I do not for a minute think this is garbage in.

Regarding those who post on HW, it is much more likely that we get a skewed sample. I post a lot because PC is on my mind, especially with my bad pathology. If all was going great, I'm sure I would be less preoccupied with this and for sure I would be posting less.

Many have just done well and gone on with their lives. So, the BS is assuming that HW represents a total cross-section of PC patients. In facts, it represents only those who choose to post here.

Like you, I am disappointed as MSK gave me glowing chances pre-surgery and it didn't work out. Probabilities are not guarantees.

Mel

All that has been said does not negate the validity of nomograms. I affirm what compiler said in his post. HW and other sites have a skewed population of men who are dealing with pre and post treatment issues. It does not reflect the population that considers the episode they had with PC as a bad but momentary chapter in their lives and have moved on to new concerns. If HW reflected the general population of those who have or have had PC then the site would be glutted with Gleason 6, OC guys with a very small percentage of them having BCR issues.

I am just speculating, but as a student of marketing I might be persuaded to think that a small hospital would use some razzle-dazzle website ploy to induce customers to use a particular facility for treatment. However, the quality of the treatment would be reflective of the statistics a urologist has on patients he or she has treated, not made up number or outrageous claims on a website. Perhaps to push this fantasy out further, if Sloan Kettering were out in the middle of nowhere rather than in the heart of Manhattan, I might give an ounce of thought to their using a nomogram to attract customers. ESPECIALLY, if they were not the creators of the nomogram but just mooching one off of another site. New York alone would provide plenty of business for them. SK is known throughout the world and people from all over come to NY to get treatment from them.

I will declare my bias up front. I don't believe that centers of academic excellence such as Sloan Kettering, Mass General, Johns Hopkins, Mayo Clinic, UCLA Medical Center, UC San Francisco Med Center and others in the same strata of hospitals have to resort to snake oil trickery to function successfully. These places get plenty of business without advertising because for those who do their homework and read the academic papers produced by the staff from these institutions, it is easy to see that they are doing lots of research, finding new therapies, conducting trials, getting grants to fund research and BEST OF ALL, have excellent statistics for patient outcomes. Many are drawn by that level of academic/treatment skill and insist on having the treatment they choose done in these big name institutions.

The nomograms are not wrong just because an individual fell outside of the predictive indicators of the scores generated. If you read the research that contributed to the nomograms, a certain percentage will beat the odds. It goes both ways. Some Gleason 6 PSA < 2.5 T1C men will get metz and some Gleason 10 PSA >10 T3 men will never succumb to PC. It will happen. The predictive value of the nomogram is not diminished. It allows for these variations but it is not so customized that it provides individual tailored results.

Last, what I find amazing is that the stats from some academic centers of excellence are so good. For a lot of people, the choice to go to these places is one of being the last best chance of getting a good outcome. These centers get more than a fair share of high grade diseases to treat. Some do well but others cannot be saved by even the best of treatments because the window of curability or some salvage therapy is long gone.

142 - I am so glad you have beaten the odds and are here to bring new hope to those who seek this site for support.

Mike S.

Let me simplify things and get answers from the HW group

Gleason 6 before and after
pre surgery psa 3.0 T1c
4 in 12 core cancer on pre surgery biopsy .... 1- focal 1 -10% 2 - 25 %


Post surgery gleason 6
positive margin (one question on sloans site)
everything else negative, which is great
epe ---inconclusive, because of nerve sparing surgery (consider negative)
all cancer on left side....
Great recovery ...no ED or incontinence

MSK nomogram has me at 98 % chance of no BCR at 10 years....simple question..

If all of HW members voted, based on what they know..... Would 98% of them state that these stats would bring a 98% success rate of no BCR at 10 years... (remember the positive margin)