Post-Radical Prostatectomy

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Our post-radical prostatectomy nomogram can be used by patients after their surgical treatment for prostate cancer. This nomogram predicts the probability of remaining cancer recurrence-free at two, five, seven, and ten years following surgery. Using dynamic statistical formulas, this nomogram draws on data from more than 10,000 prostate cancer patients treated at MSK.

Researchers can access the coefficients and model properties by clicking here.

The results of this nomogram will apply to you if radical prostatectomy was the only treatment you received for your prostate cancer AND if your serum PSA level has been undetectable (less than 0.05 ng/mL) since surgery. If you received radiation therapy or hormone therapy (Lupron, Taxotere, Casodex, Eulexin, Zoladex, etc.) prior to surgery, the calculations of this nomogram will not be accurate.

Prostate cancer recurrence is present after radical prostatectomy when the PSA measurement has reached 0.2 ng/mL and continues to rise, and has been confirmed as such on a repeat measurement.

Results produced by this tool are based on studies conducted at large research institutions with surgeons who perform a high volume of prostate cancer procedures. All results must be understood in the context of each patient’s specific treatment plan. Patients and caregivers using this tool should discuss the result with the patient’s physician.

To gather the information required to use this nomogram, use our worksheet.

Enter Your Information

All fields are required unless noted optional

Disqualifying Treatments

If you have received either hormone or radiation therapy for prostate cancer — if you answer “yes” to either of the following two questions — the results of this nomogram will not apply to you.

Have you gotten hormone therapy (e.g., Lupron, Taxotere, Casodex, Eulexin, or Zoladex) for prostate cancer OR plan to get it?
Have you gotten radiation therapy for prostate cancer OR plan to get it?

General Information

What is a dynamic nomogram?

Most medical prediction models come from published studies based on fixed groups of patients. 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.
More on risk prediction based on dynamic models.

ng/mL (0.01 to 100)
years (20 to 100)
months (0 to 120)
Note: This is only used for prediction of recurrence.

What is your Gleason score on surgery?

To use this nomogram successfully, you will need to know your primary and secondary Gleason pattern numbers after surgery.

How are Gleason patterns/scores determined?
Physicians characterize the aggressiveness of prostate cancer using the Gleason scoring system, which provides an estimate of the cancer’s potential to grow and spread to other parts of the body. The pathologist determines the Gleason pattern based on how closely the cells of the gland resemble those of a normal prostate. All the cores of tissue taken during a biopsy are examined by a pathologist, who assigns a pattern number to the largest area of cancer in each core (known as the primary Gleason pattern), and a second pattern number to the next most common area (known as the secondary Gleason pattern). The two pattern numbers added together are the Gleason score. If more than one biopsy core contains cancer cells, the patient’s overall Gleason score is determined by the core with the highest Gleason score.
The score will be automatically calculated from the sum of the primary and secondary Gleason pattern numbers from the radical prostatectomy pathology report

Prostatectomy Pathology Report Details

Were your surgical margins positive?
What are positive surgical margins?
Surgical margins are positive if cancer cells are present at the edges of the removed prostate.
Was there extracapsular extension?
What is extracapsular extension?
Extracapsular extension is cancer that extends into or outside the prostate “capsule” or organ, as determined from the radical prostatectomy pathology report.
Was cancer present in the seminal vesicles?
What are seminal vesicles?
The seminal vesicles are glands that help to produce semen.
Was cancer present in the pelvic lymph nodes?
What are pelvic lymph nodes?
The pelvic lymph nodes are small glands that filter fluid made in the prostate; they can be an early site of prostate cancer spread.

Clinical Stage and Biopsy Gleason Pattern and Score (Optional)

Information on clinical stage and clinical grade is optional. The nomogram can provide predictions without this information if not available. However, using this information, the nomogram can provide more accurate predictions. The nomogram will provide predictions incorporating clinical stage and biopsy Gleason grade data if both clinical stage and primary and secondary biopsy Gleason pattern numbers are entered. If clinical stage and/or biopsy Gleason pattern numbers are not entered, the nomogram will provide predictions without information on clinical stage and biopsy Gleason grade.

Clinical tumor stage is determined by digital rectal examination and does not include stages determined by imaging studies.

Note: Although it is possible to be stage TX or stage T4, this nomogram is not applicable for these stages.
More on clinical tumor stage

The global standard in prostate cancer staging is the TNM Staging System, which uses tumor, lymph node, metastasis (TNM) classifications to describe the extent of cancer in a patient's body. T describes the size of the tumor and whether it has invaded nearby tissue; N describes whether regional lymph nodes are involved and, if so, how extensively; and M describes whether distant metastasis (spread of cancer from one body part to another) is present.

The system is maintained by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) and is updated periodically, most recently in 2009/10 (Version 7).

The following are clinical tumor stages for prostate cancer from the 2010 edition. These stages are listed on the pathology report.

  • TX: cannot evaluate the primary tumor
  • T0: no evidence of tumor
  • T1: tumor present, but not detectable clinically or with imaging studies
    • T1a: tumor was incidentally found in less than 5% of prostate tissue resected (for other reasons)
    • T1b: tumor was incidentally found in more than 5% of prostate tissue resected
    • T1c: tumor was found in a needle biopsy performed following an elevated serum PSA result
  • T2: the tumor can be felt (palpated) on examination, but has not spread outside the prostate
    • T2a: the tumor is in half or less than half of one of the prostate gland's two lobes
    • T2b: the tumor is in more than half of one lobe, but not both
    • T2c: the tumor is in both lobes
  • T3: the tumor has spread through the prostate capsule (If the tumor has spread only part-way through, it is still T3.)
    • T3a: the tumor has spread through the capsule on one or both sides
    • T3b: the tumor has invaded one or both seminal vesicles
  • T4: the tumor has invaded other nearby structures
The score will be automatically calculated from the sum of the primary and secondary Gleason pattern numbers from the biopsy report.
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