From the Guidelines
Nomograms, such as the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram, should be used to predict outcomes after treatment for node-positive prostate cancer, as they provide individualized estimates of survival probabilities based on factors like PSA level, Gleason score, and lymph node involvement. When considering prognosis for node-positive prostate cancer, it is essential to use a nomogram that incorporates the most relevant prognostic variables, regardless of value 1. The NCCN Prostate Cancer Panel recommends using NCCN risk groups to begin discussing treatment options and nomograms to provide additional, individualized information 1.
Key Factors in Nomogram Use
- PSA level
- Gleason score
- Clinical stage
- Lymph node involvement
- Extent of nodal disease
Nomogram Applications
- Predicting 5-year and 10-year biochemical recurrence-free survival
- Predicting metastasis-free survival
- Predicting overall survival
- Guiding treatment intensity and follow-up protocols
Limitations of Nomograms
- Do not account for all patient-specific factors
- May not reflect evolving treatment paradigms
- Should complement, rather than replace, clinical judgment 1
By using nomograms like the MSKCC nomogram, physicians can provide personalized risk stratification and guide treatment decisions for patients with node-positive prostate cancer, ultimately improving outcomes and quality of life 1.
From the Research
Nomogram for Prognosis of Node Positive Prostate Cancer
- The development of a nomogram for prognosis of node positive prostate cancer would require consideration of various factors, including Gleason score, PSA level, and nodal burden 2.
- A study published in the European Urology journal in 2019 found that biopsy grade group and preoperative nodal burden were significant predictors of clinical recurrence in patients with clinically node-positive prostate cancer treated with radical prostatectomy 2.
- Another study published in the International Journal of Radiation Oncology, Biology, Physics in 2018 found that definitive radiation therapy and androgen deprivation therapy were associated with improved prostate cancer-specific mortality and all-cause mortality in patients with clinically node-positive prostate cancer and lower baseline PSA levels 3.
- The role of radical prostatectomy and lymph node dissection in clinically node-positive patients is still being debated, with some studies suggesting that it may be a reasonable option in selected patients 4, 2.
- A scoping review published in the Cancers journal in 2023 found that the best-established treatment option for patients with clinically node-positive prostate cancer is a combination of androgen deprivation therapy and external beam radiotherapy applied to both the prostate and lymph nodes 5.
- The Gleason score has been shown to be a powerful predictor of cancer behavior and a significant predictor of progression to androgen independent prostate cancer 6.
Factors to Consider in Nomogram Development
- Gleason score: a higher Gleason score is associated with a higher risk of progression to androgen independent prostate cancer 6.
- PSA level: a lower baseline PSA level is associated with improved prostate cancer-specific mortality and all-cause mortality in patients with clinically node-positive prostate cancer treated with definitive radiation therapy and androgen deprivation therapy 3.
- Nodal burden: a higher nodal burden is associated with a higher risk of clinical recurrence in patients with clinically node-positive prostate cancer treated with radical prostatectomy 2.
- Biopsy grade group: a higher biopsy grade group is associated with a higher risk of clinical recurrence in patients with clinically node-positive prostate cancer treated with radical prostatectomy 2.