Over the past decade, Kattan, Scardino, and colleagues have been gradually extending the reliability and the capabilities of the so-called Kattan nomograms to accurately predict outcomes to a variety of treatments for prostate cancer (at various stages). The latest evolution of these tools is their so-called “Trifecta nomogram.”
Freedom from biochemical recurrence, together with the full recovery of continence and erectile function, is the optimal outcome after radical prostatectomy for clinically localized prostate cancer. The “Trifecta nomogram” can now be used to project the likelihood of such an ideal outcome, based on the usual collection of preoperative data.
The nomogram is based on records of 1,577 men, with an average age of 58 years and an average presurgical PSA of 6.4 ng/mL, who had open radical prostatectomy for clinical stage T1c-T3a prostate cancer at Memorial Sloan-Kettering Cancer Center between 2000 and 2006. Men were excluded if they received preoperative hormonal therapy, chemotherapy or radiation therapy, if pretreatment prostate specific antigen was more than 50 ng/ml, or if they were impotent or incontinent before radical prostatectomy. Freedom from biochemical recurrence was defined as a post-surgical PSA of < 0.2 ng/ml. Continence was defined as not having to wear any protective pads. Potency was defined as erection adequate for intercourse upon most attempts with or without a drug like sildenafil (Viagra) or taladifil (Cialis).
Cancer-free status, with recovery of continence and potency (a trifecta) was achieved in 62 percent of these patients. The nomogram developed on the basis of these data permits patients to estimate preoperatively their likelihood of an optimal outcome after radical prostatectomy.
The “Trifecta nomogram” is not yet available on line as part of the complete set of Kattan nomograms for prostate cancer, but we assume that it will be in the not too distant future, again expanding the range of this very valuable set of predictive tools.
It is also worth noting that Dr. Kattan has been working on similar predictive tools for other types of cancer and for other disorders too.
Filed under: Management, Tips, Treatment
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