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Opinions of difference between Sloan Kettering nomogram and John Hopkins Discovery publication

456 retired
Posts: 3
Joined: Mar 2017

Gentlemen,

Does anyone have a opinion of the vast difference between the predictions of the Sloan Kettering nomogram and the tabulations of the John Hopkins James Buchanan Brady Discovery publication. The Hopkins original article is back in 2005 but reconfirmed in 2015. Question is how can two highly regarded institutions seem so far apart in predictions based on the same information. I'm trying to decide where to go from here. Thanks for your thoughts.

ASAdvocate
Posts: 115
Joined: Apr 2017

Can you please cite the areas of disagreement?  It is not simple for others to have to look up those issues.

And, are you looking at initial diagnosis, or recurrence...or what?

Please provide us with more detail on your history to help us knoiw how to respond to you.

456Retired
Posts: 4
Joined: Sep 2017

Gentelmen,

My apologies for incomplete information. I had DaVinci surgery in 2010 pushing back the PSA to less than .008 for 44 months. A slow, gradual, eratic increase came to .238 in 82 months. My Gleason is 3+4 (7) and the doubling time is 17.7 months by Sloan Ketterings onlime calculator. Their "Risk of dying of prostate cancer in men with a rising PSA after radical prostatectomy" on line prediction tool predicts a 99% chance of dying in 5 years. Scary. 

On the other hand, The John Hopkins Urological institute wrote in their "Discovery" publication in 2005 and recomfirmed in 2015 that three functions are important in predicting prostate cancer increase. PSA doubling time greater than 15 months, that I have. Gleason 7 or less, that I have. And time of return after surgery, three years or after, that I have. Their tables suggest a 94% chance of surviving 15 years without additional therapy. I'm 72 in good health otherwise, and am concerned about complications of salvage radiation that "may" have a 60% chance of success. I'm one of the "intermediate" gap guys between you don't need additional therapy and you must do additional anything to stay alive. We all have a "use by date" but it difficult to think about. Thanks for your input.

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3276
Joined: May 2012

456,

You're obviously smart and well-read, and I mean the following only to be helpful.  I have never studied either Predictive model myself in any detail, either the SKCC, or Johns Hopkins.  But I think it possible that you somehow made a mistake in plugging in values with SKCC.  The result you got was astronomically outside morbidity rates generally.  And as you yourself note, the results are 180 opposed to Johns Hopkins.    

Several years ago, average survival rates of PCa in the US for men first diagnosed with Stage IV metastatic disease (the worst possible initial diagnosis) were well over 5 years.  But SKCC predicts a man dead in under 5 years, with a miniscule PSA ?   It does not fit.

max

SubDenis's picture
SubDenis
Posts: 130
Joined: Jul 2017

As suggested try redoing the SKCCe  I guessed at some of your numbers and got a very positive report.  Denis

contento
Posts: 76
Joined: Jul 2017

456retired, I agree with SubDenis, please run your numbers again on the MSK nomogram as I ran what you provided using some worst cases for info you did not provide and i got very good statistics.

456Retired
Posts: 4
Joined: Sep 2017

Gentlemen,

As suggested by contento, I ran the nomogram again subtituting "alternate facts". Rather than the 82 months it took to get to recurrence I inputed 2 months. It then computed a 2% chance of dieing in 5 years rather than the 99% chance of dieing with a 82 month recurrence gap. I'm thinking SNAFU. What do you guys think?

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

Sincerely, I do not understand how someone could check the results of the prediction estimates of your interest without the necessary data of your case and you. For the SKCC prediction tools, the first missing important information regards the PSA before surgery. The second missing data is the findings after surgery (pathology report), which you have not shared here.

https://www.mskcc.org/nomograms/prostate/biochemical-recurrence

In regards to the JH publications, the most famous prediction tools are the Partin Tables and Han Tables used before surgery. I think that you are discussing above about their RISK FACTORS for prediction of a lethal prostate cancer. I am not aware that they have a prediction table of death by PCa. Can you provide the link?

http://www.hopkinsmedicine.org/Press_releases/2005/07_26a_05.html

http://www.hopkinsmedicine.org/brady-urology-institute/specialties/conditions-and-treatments/prostate-cancer/fighting-prostate-cancer/partin-table.html

http://www.hopkinsmedicine.org/brady-urology-institute/specialties/conditions-and-treatments/prostate-cancer/fighting-prostate-cancer/han-table.html

In any case, I understand your worry in regards to the complications that a salvage radiation therapy (most recommended for surgery failures) can bring to you, in particular because it may turn your well being (... I'm 72 in good health otherwise...) into a loss of quality of life. However, if your concern is the length of your extended living period, your Life expectancy, you should consider that death is not predictible by just the PCa variable. Your other expected health issues are in play and those should be also checked periodicaly. For instance, bone loss, cardiovascular diseases, diabetes, renal disease, etc.In this link you got another predictable table that includes other parameters;

https://link.springer.com/article/10.1186/s12916-016-0572-z

Many of us survivors at the 70th with good health otherwise are surprised with occurrences that in fact should be expected but never were thought to occur. Unfortunately, we cannot escape aging and this process engraved in our genes is, most of the times, behind the health issues we encounter, including prostate cancer.

I believe that your main interest is an opinion regarding a different subject. Something on "Treating or not to Treat" a recurrence, which obvious everyone would recommend to do if the patient is 72 years old and in good health otherwise. Death by PCa is reported to be painful and nasty. Surely radiation is not the only way to control recurrence so that you may find that an alternative treatment such as ADT may be more acceptable to you.

I hope my post is of help and that you find the peace of mind regarding your doubts.

Best wishes in your journey.

VGama

456Retired
Posts: 4
Joined: Sep 2017

Gentlemen,

I appreciate the extensive informational posts particularly from VGama. I had not seen the Springer info before and it will take a couple of readings to have it sink in.

I'm still confused of the difference between the Sloan Kettering and John Hopkins pathology direction. John Hopkins clearly suggests that the longer time period between surgery and return of PSA, the better the outcome. On the other hand, filling in the blanks of the Sloan Kettering nomogram suggests a shorter time period has a better outcome than longer.

My pre surgery PSA was 3.8. Biochemical recurrence .238 at 82 months. Gleason 3+4(7). PSADT 17.3 months. No extracapsular extension, lymph node, seminial vesticle or positive surgical margine. No radiation or hormon therapy. I'm 72. Inputting this data in the SK nomogram states I have a 99% chance of dying from cancer within 5 years. Changing ONLY the length of time to biochemical recurrence arbitrarily to 2 months, states I would have a 2% chance of dying within 5 years. Johns Hopkins says longer time period is better, Sloan Kettering shorter. Obviously, we don't get to choose any criterion. But who's judgement is more accurate?

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