I am posting these 2 calculators for use by men who are making a treat/don't treat decision, as well as for men who have had initial treatment.
For the 1st calculator/nomogram, input of your age before possible treatment, Gleason score, stage, and other health issues provide a result showing expected probability of cancer death after 10-15 years, for a man who chooses to avoid any treatment. I will inquire, but as of today I'm not certain of the source of data for this calculator......MSK has an excellent reputation, so I'm assuming they have used a credible data source.
So, here is life expectancy assuming no treatment......
I know that the second calculator is based on MSK's prostate cancer patients who had surgery performed at MSK ......many thousands of men. The results include PCa mortality at 10-15 years, as well probability of experiencing recurrence, which is called progression at MSK. Here is that calculator, for patients who have had surgery........
I hope that these calculators can help some men as they make big decisions re future treatments, and maybe serve as basis for discussions with your Docs.
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maley2711
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Yes, the model should say upfront it doesn't work with LN+. I went back and entered L0 (actually have one), and it gave me 37/100 to live 15 years with no other risk factors.
Of course, if you have additional info that the model doesn't factor, then its result will be more or less favorable than the number that is generated based on limited data. That is NOT a flaw...it is an obvious limitation, which I would expect folks to understand?
The flaw is it allows N1 as an input, then kicks out a null response at the end. so it is a flawed model in that sense, because folks have to enter all their data to find out at the end that it's a limited model-- should say upfront or not allow an N1 input-- I would expect folks understand that?
Thanks for sharing this. I am not sure either has much value. Medicine moves too fast to calculate life expectancy, i.e. in my case. When I was diagnosed zytiga, xtandi, Provenge, improved radiation did not exist. New drugs and genetic treatments are moving into mainstream medicine.
The value would be that......as you state, new treatments are improving outcomes, So, then the calculator would provide the worst case probability, not the best case based on the new developments.
Consider what the site says about the info provided: "Imagine that there were 100 men like you: the same age and overall health, and the same prostate cancer [then] this is what we would expect to happen..."
But of course while many of these men are SOMEWHAT like you in general terms of health and cancer stage/type, we have no idea how many are EXACTLY like you in more specific terms of genetic mutations, microbiome, hormonal milieu, metabolic dysfunction, diet, exercise, sensitivity and response to specific nutrients/meds, etc.
I read that (for a 60-yo w/ Gleason 3+4 and PSA 10) there are 98 out of 100 men who don't die of PC if they undergo RP and there are 87 out of 100 men who don't die of PC if they DON'T undergo RP, after 15 years.
So one way of thinking about the fifteen-year survival times is that there might be about a 10% likelihood that you are among the men that RP seems to help keep alive. That is quite different than thinking in terms that six times as many men in the non-RP group will end up dead of PC! With the former view, you might say "why bother with RP" and the latter view would tell you "get it out now."
But do we even know that it is the RP itself that is fully responsible for the survival benefit? For one thing, RP patients KNOW they have had the primary tumor removed and men in the non-RP group KNOW they have NOT had the primary tumor removed. To account for placebo/nocebo effects, we'd need a comparison of a group that THINK they had an RP but actually didn't. (Such a study showed that a particular knee surgery had no statistical benefit over placebo, but of course ethics prevent such a study from occurring with PC.)
There are probably other lifestyle and psychological and medical-care factors that might vary between the post-diagnosis "RP group" and "non-RP group" and could be contributing factors to a difference in fifteen-year cancer survival. One obvious difference is that post-RP monitoring of PSA and potential follow-up treatment would seem likely to be more aggressive in those men than in men who never had their prostates removed.
In the end, we all become part of the the statistical aggregates. But we each have some unique attributes, as well as the commonalities, that will help or hurt many of us as we individually experience better or worse survival times than what a "normal" man (and a hundred just like him) might experience.
Yes, the treatment numbers are just the result of many thousands of men treated at MSK, over many many years. There could be factors that give one man better odds than another man...though both had same stage, Gleason etc. I don't foresee the type of models that some men here seem to expect... I for one appreciate that MSK has provided these.....for me, something is definitely better than nothing. But, that's just me.
I posted these calculators with good intentions, with no claim made about application to individual situations.
Yes, I'm not saying there is anything wrong with posting them, or that you have made any claims about them. They are what they are. I'm just pointing out for men who DO use them that they may not mean what we might think they mean, so far as how one might use this info to make a decision.
Also interesting is that I see the untreated cohort is from Swedish data, which means even more potential differences (cultural, genetic, SOC, etc.) between the RP group and non-RP group. One comes immediately to mind: less "quality" sunshine for Swedes?
My brother-in-law had a RP in 2009 and was claiming that with the prostate OUT, he will not have any problems.
Surprise, in 2014 he had a recidive and needed a Salvage RT with ADT.
Then last year another recidive and now on ADT + Chemo.
Thank you . Did the test. Unable to give me expectancy due to lymph node and metastatic nature of my pc . They can’t give me anything. Docs said I’d be dead a year and a half ago. Predictions of survival are futile. Life is in Gods apt hands.
I agree that trying to "model" our advanced cases of metastatic prostate cancer often involves just too many individually unique variations in the evolving biology of our disease, the types and locations of "mets", and the many combinations of both newer and older treatments that may not have even be available just a few years ago.
"Just starting out" though, either just before or right after initial prostate surgery, there could still be some value in something like the MSKCC Nomograms. While it is true that they derive their data from more than 10,000 patients treated at MSK, some of whom were treated years ago before new follow-on treatments were available, the models themselves are pretty sophisticated, and the various factors in them are updated several times each year, giving more weight to more current data.
Here's their blurb about them.
"The statistical formulas for these models therefore do not change as new information becomes available. In contrast, the "dynamic" model used here — with the exception of the calculation for survival probability — draws on data from more than 10,000 prostate cancer patients treated at MSK. The model is updated several times a year as the MSK database accumulates new data, with more recent patients given more weight in the statistical analysis than patients treated many years ago. As a result, the statistical formula for the model changes slightly over time."
Here's another link to those handy Nomograms and other related Tools.
Here's a peek inside the actual mathematics and dynamic factors that drive the "Pre-Op" MSKCC Nomogram that might be considered before making an initial treatment decision.
Thanks ctarleton> I had never shared anything here before, and after reading most of the responses, was fairly discourage about the negativity exhibited in the responses? Complains about limitations of the calculator...when clearly these calculators are not intended for all situations. One is a pre-radical prostatectomy calculator....to illustrate to someone the probabilities of mortality from PCa and other causes, and also the probability of recurrence, even with treatment.
The 2nd calculator provides numbers on probabilities for men who choose to avoid any treatment. As Dr. Eastham at MSK kindly responded today, this calculator uses Swedish data. So, I do not know if I would place the same confidence in the probability numbers generated from that data?
I tried the calculators for stage T1c and Gleason 3+4, for a man healthy in other ways. Simplifying , the respective results told me that 6 of 100 men with such overall characteristics would die of PCa without treatment, whereas MSK treatment would reduce that number to one man of 100 dying from PCa over 15 years. For these numbers, considering treatment side effects, perhaps a number of men would choose AS??
Also to be noted, the MSK numbers for treatment reflect that many men had followup treatments after failure/ recurrence/progression, which the calculator showed happening in 30% of the cases......for a man with Gleason 3+4, T1c, etc.
To put these numbers in context, I believe PCa cause approx 3% of all male mortality. So, for men with T1C and Gleason 3+4, electing no treatment would double the probability of PCa death, versus the general population of men. Treatment would seem to reduce probablility to 1%, so that is good!!
You are misinterpreting the numbers from such a nomogram.......it shows only probability...it does NOT predict an individual's outcome!!! For others who seem to be critical.....sorry.
And for further elucidation, I contacted Dr. Eastham at MSK again, and he was kind enuf to respond again! The calculator that shows your probability of dying in 10-15 years with ZERO treatment is based on a Swedish database for men who made that decision.
Yes, does not show life expectancy. I think we can leave it to each individual man to decide wheter or not to try any particular nomogram...and then decide if the results mean anything to them. I assume that most men are intelligent enuf to understand the nomograms linitations...and that they do not represent a prediction for an individual, just probabilities based on results for a large number of men.
Some of us do not believe that God determines things....we're all free to believe what we believe, as long as our beliefs don't bring harm to others...IMHO.
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