The 2007 Fleshner
[Dr. Shaw's personal website]
an experimental tool to evaluate post-biopsy D'Amico or JUA low-risk cancers...candidates for
brachytherapy or watchful waiting (active surveillance)...to predict from biopsy & clinical
parameters the likelihood that findings in a prostatectomy of that case would cause a
postoperative Gleason upgrade (nomogram helps avoid under-treatment by flagging cases for
further consideration of advisability of caution about any conservative management
NOTE: the nomogram does not know how to "back out"
the inflammatory portion of elevated PSA, if the case has significant prostatitis
Factors needed to work the
nomogram: patient's age, total serum PSA value, whether the pathologist is highly
experienced at reading prostate core biopsies (uro-path) or not (other), whether urologist's
DRE exam of patient is normal or not, whether biopsies contained any PIN or not, the prostate
volume by TRUS calculation, whether TRUS exam found any hypoechoic areas (positive) or not
(negative), whether the biopsies were taken in a "sextant" 6-core procedure (systematic) or
an extended series (more than six biopsies) procedure, and the sum of all cancer segments
divided by the sum of lengths of all the biopsy cores (to calculate CA Percentage). For each
factor point/value, bring a vertical line upward to the "points" line and note the
value where the lines intersect. Finally, sum the points for each factor and plot that sum on
the lower "total points" line. from that sum point, drop a vertical line to the "probability"
line below in order to see the probability that your case would contain Gleason upgrade if
the whole prostate were examined.
We recommend the journal,
Cancer, and have placed this graphic on the website in order solely to make it more convenient for
our uropathologists to use this nomogram in cases they wish to test.
personal WEB-FILE of info for
prostate cancer patients & their "significant others"
Our pathology group's TOC WEB-FILE on prostate cancer issues
et. al. & Fleshner
Neil E. (Toronto, Canada), Clinical Predictors of Gleason Score Upgrading, Cancer 109(12):2432-38, June 15, 2007. The nomogram chart is on page
***give me your comments about this
check out the Highest
(posted 20 December 2007)