Nomograms

Introduction

Prostate cancer (PCa) is not a disease with a lot of clear-cut decisions.

• In the diagnosis of PCa, it is important to predict which men have a high likelihood of a positive biopsy.
• Once PCa has been diagnosed, it becomes crucial to predict which men will have an aggressive fast progressing tumour that requires active treatment.

Single clinical variables alone do not predict the outcomes of prostate biopsy or the risk of tumour progression. A combination of various clinical variables can give the best prediction of these outcomes in individual subjects. These include:

• age
• outcome digital rectal examination (DRE)
• serum prostate specific antigen (PSA) level
• Prostate CAncer gene 3 (PCA3) Score
• Gleason score in biopsy
• percentage of positive cores
• stage (TNM: tumour, nodes, metastases)

Risk calculators such as predictive tables and/or nomograms which integrate the various clinical variables have been developed to facilitate patient counselling and joint decisions in these matters.

Available risk calculators

Several tools from different PCa research institutions have been developed to predict the risk of a positive biopsy or PCa progression. In addition, many hospitals/urologists have developed their own risk calculator(s) based on their own patient population.

Table 1 below provides a selection of well-known, mostly US population-based, risk calculators assessable through the Internet. They differ in the type of clinical data which have to be known for calculating the risk, also in relation as to whether the individual patient has

• not (yet) been diagnosed with PCa (i.e. pre-biopsy)
• not (yet) been treated (i.e. pre-operative in patients who have a positive biopsy).

Calculating the risk of prostate cancer progression

To select appropriate risk calculators, please choose one of the options below.

• Suspected PCa pre-biopsy (abnormal DRE / elevated PSA)
• Confirmed PCa pre-operative (positive biopsy / pre-treatment)