In a retrospective analysis of prostate cancer patients treated with brachytherapy between 1992 and 2000, researchers found that the nomogram offers about 66% accuracy in predicting five-year prognosis following the treatment. According to the results of the study, which are published in the September issue of Urology, 80 percent of patients remained free of disease recurrence five years after seed implantation.
"The pretreatment nomogram is useful to physicians and patients in estimating how successful brachytherapy will be based on individual factors such as PSA levels, Gleason score, and the stage of the patient's disease," said Michael Kattan, PhD, a researcher at Memorial Sloan-Kettering and lead author of the study. "Rather than relying on general risk groups of patient populations who share similar characteristics, nomograms provide specific information that will help a patient decide which treatment option for localized prostate cancer will offer him the best prognosis."
The study authors have facilitated the computations of all three nomograms by compiling the statistical aids into a palm-based software application called Prostogram, which is available to physicians free of charge a http://www.nomograms.org .
The brachytherapy nomogram was developed using information from the medical records of 920 patients treated at Memorial Sloan-Kettering Mercy Medical Center in Rockville Centre, New York. Researchers used data from more than 2,000 other patients treated at the Seattle Prostate Institute and Arizona Oncology Services to validate those results, representing the largest study yet of prostate brachytherapy with permanent implants.
"This pretreatment nomogram will provide a beneficial tool to help weigh the risks and benefits of brachytherapy," said Peter Scardino, MD, Chairman of the Department of Urology at Memorial Sloan-Kettering and senior author of the study.
However, the study authors emphasize that the development of the present nomogram was based on a group of patients already treated with brachytherapy, and both physician and patient biases affected the selection of treatment among these patients, as is the case for both the surgical and radiotherapy nomograms. "The role of all the pretreatment nomograms will be better defined in a larger decision analysis which incorporates individual patient preferences into the decision making process," added Dr. Scardino.
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Journal
Urology