Prognostic Nutritional Index (PNI)

After reading the excellent series of posts by pjoshea13 on the correlation of systemic inflammation with PCa, I did some Google search and landed on the following 2018 paper:

"Prognostic value of selected preoperative inflammation-based scores in patients with high-risk localized prostate cancer who underwent radical prostatectomy".

ncbi.nlm.nih.gov/pmc/articl...

The most important index there, i.e. vested the highest statistical significance, is PNI. Don't confuse it with PNI, aka PeriNeural Invasion, cited in biopsies. It is a totally different thing. It is a weighted sum of serum Albumin and Lymphocytes count. For average normal values of Albumin 4.5 g/dl and 2500 Lymphocytes per μl, or mm^3, the PNI formula gives: 10x4.5 + 0.005x2500 = 45 + 12.5 = 57.5

For a prognosis on biochemical recurrence post-RP the authors state a cutoff value of 47.4 (higher being better).

"Conclusion: High dNLR, high PLR, and low PNI were associated with poor biochemical recurrence-free survival in patients undergoing radical prostatectomy for high-risk localized prostate cancer not treated with neoadjuvant ADT. In particular, PNI was an independent prognostic factor for biochemical recurrence."

Checking my historical data PNI was hovering between 59 and 57 from 2000 to 2015 when my PSA was <2.3. Post-RP, 9 months ago, it has come down to 53.4 - 51.7.

There is also another earlier 2017 paper, for advance PCa titled:

"Prognostic nutritional index predicts initial response to treatment and prognosis in metastatic castration‐resistant prostate cancer patients treated with abiraterone".

onlinelibrary.wiley.com/doi...

[LearnAll]

Thanks for sharing this important study. I have been tracking my NLR and PLR since begining. Now, I will also start calculating PNI.

This once again emphacizes the fact that inflammation plays a significant role in intiation and progression of PCa..

In spite of some ignorant folks getting offended unnecessarily , I will say once again that plant based anti inflammatory foods, Herbs and spices REDUCE systemic inflammation and thus, help slowing growth of PCa. Meat and animal products increase systemic inflammation.

[Hidden in reply to LearnAll]

According to the same paper dNLR (d for derived) led to slightly better numbers than NLR.

[LearnAll in reply to Hidden]

how do you calculate dNLR?

[Hidden in reply to LearnAll]

N /(W-N) The denominator is equal to L plus everything but N.

[LearnAll in reply to Hidden]

Thanks. I just calculated my PNI. At height of my Pca symptoms..PNI was 25 and now ,8 months after treatment,it has come up to 56.

[Hidden in reply to LearnAll]

You are welcome. Your case strengthens the content of the study.

[LearnAll in reply to Hidden]

I had two flares of symptoms..first when I was diagnosed and that time NLR was 3.75 and PLR was 123. Second flare caused NLR 8.5 and PLR 164. Since then, NLR have been between 1.0 and 2.2 and PLR has been between 56 and 104.

Its interesting to watch that these parameters can give a good glimpse about what is going on inside. This data corelates with PSA of 0.4 now.

[Hidden in reply to LearnAll]

With your numbers I will run a crude sensitivity analysis tomorrow. It will target distances from the quoted cutoff values expressed in standard deviation units for the three indices.

[Hidden in reply to LearnAll]

Disclaimer: The following evaluation can be easily challenged for poor statistical manipulations. It is only a crude first attempt. Having admitted that and assuming PNI=25 was derived from the same data that led to NLR=8.5 and PLR=164 the paper distinguishes between two options:

1) ADT before = No

NLR: (8.5-2.1)/3.1=2.06 SDs

PLR: (164-100.7)/45.1=1.40 SDs

PNI: (25-47.4)/7.3=-3.07 SDs

2) Similarly, ADT before=Yes

NLR: (8.5-3.2)/3.1=1.71 SDs

PLR: (164-63.9)/45.1=0.82 SDs

PNI: (25-52.4)/7.3=-3.75 SDs

We can note the following:

a) In both cases, indicators' ranking in terms of sensitivity is PNI, NLR, PLR, in agreement with the paper.

b) Prior ADT attenuates the sensitivity of NLR and PLR, but improves that of PNI.

PNI to NLR distance in absolute values for 1) is (3.07-2.06) = 1.01 SDs, vs (3.75-1.71) = 2.04 SDs for 2). In signed values said distance for 1) is (2.06-(-3.07)) = 5.13 SDs, vs (1.71-(-3.75)) = 5.46 SDs. Both metrics show a strong shift in favour of PNI.

c) The cohorts of 1) and 2) were desimilar in population numbers (380 vs 60) and disease characteristics. No direct comparison should be attempted.

[LearnAll in reply to Hidden]

Just...its too complex statistics for me. Just tell what is the prognostic implications of these numbers for me ?

[Hidden in reply to LearnAll]

PNI appears being better index to watch. On a number of occasions pjoshea13 has cited a hint given to him by a knowledgeable person regarding Albumin being the best indicator for PCa disease progression.

[Hidden]

Well, I think that not believers question the reciprocity of the two. It is more than intuitive that cancer is a cause of inflammation.

[LearnAll in reply to Hidden]

Its also the reverse.....chronic inflammation leads to cancer.

[Hidden in reply to LearnAll]

Pray it is not. My daughter has Crohn's disease.

[LearnAll in reply to Hidden]

Sadly, chronic inflammatory conditions such as Inflammatory bowel disease is a risk factor for colon cancer. And meat eating exacerbates that risk by creating colon polyps which become cancerous later.

In a simplified way...chronic colitis can lead to colon cancer...chronic gastritis can lead to stomach cancer, chronic hepatitis can lead to Liver cancer, Salpingitis can lead to uterine cancer, chronic prostatitis can lead to prostate cancer.

A friends son had Ulcerative colitis at age 21 and all kinds of MUMAB type meds and infusions were tried with limited improvement. I researched other treatments and found out that a chinese root powder, called QUING DAI (blue color dye) successfully have been used in China for centuries for this condition. He tried Quing Dai tabs and now, for last 10 months, he is in complete remission. The GI doc was surprised when he did colonoscopy and saw absolutely lesion free colon. We told him later about this chineses medicine and he said that he has never heard about it .The only other thing he was using was CBD oil with THC and his C reactive protein came 0.2.

There is a guy I know who treats and keeps himself in remission from Ulcerative Colitis by drinking NOPAL water ( Prickly pear cactus water) In his native country, Bolivia, its a common treatment for Colitis.

[Hidden in reply to LearnAll]

Thanks for ringing the alarm.

[tallguy2]

Thank you for posting this. Very, very informative!

Starting last November I became more deliberate about eating a less-inflammatory diet. My PNI from last week's blood work is 53, which, if I am reading your post correctly, is good. In January 2019 my PNI was 46.4. So I am making progress, correct? My only concern is that lymphocytes are t-cells, which are very important in fighting disease. My number is currently 590/microliter, which is below suggested minimums (normal range is 850-3900). The PNI formula is heavily skewed towards albumin levels, so let's not lose track of t-cell counts while tracking PNI.

[Hidden in reply to tallguy2]

Your reservations are sound. Never have all your eggs in one basket, don't they say? The dNLR will make you more happy as it groups along with lymphocytes all the rest like monocytes, eosynophils, unclassifieds, etc.

[tallguy2]

Thanks, justfor. The PNI was easy to calculate. I will play around with dNLR this week. I would love to find numbers from 2011, pre-diagnosis, as well as my numbers pre-chemo and pre-Provenge, etc. This is good stuff as I am a numbers guys at heart!

[Ralph1966]

Lymphocytes count? Is it the same as "Auto Lymphocyte Absolute" ?

My "Auto Lymphocyte Absolute" went down from 1.9 k/uL last year to just 0.8 k/uL. January this year!

[Hidden]

My guess is that "Auto" refers to the processing methodology, signifying no human involvement. "Absolute" is to distinguish between this form and the alternative as a percentage of the White Blood Cells count. In all the reports I have, both forms are cited. I have read that Lymphocytes are gradually depleted by age, disease progression and treatment followed. A halving within one year surely can not be accounted to aging, so I would hope for the last one (medication taken).

[LearnAll in reply to Hidden]

lso, I increased my protein intake to 80 grams a day and that possibly increased my albumin from 3.5 to 4.3 in 2 months.