Which prediction tool to use in patient counseling

[Guest guest]

While looking for something else this morning, I came

across the Abstract posted below. Apart from the fact that I had never come

across the term ‘metagram’ previously I couldn’t help but

think how this study reinforced the fact that there is so much confusion in the

PCa world - <snip>….. 44 prostate cancer prediction tools that

assessed at least 1 of the 160 treatment/outcome combinations ….<snip>

And yet, despite this large number <snip> Many

more prediction tools are needed. <snip> Why? To confuse the issue still

further?

All the best

Terry Herbert

I have no medical qualifications but I was diagnosed

in ‘96: and have learned a bit since then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a

physician, I am painfully aware that most of the decisions we make with regard

to prostate cancer are made with inadequate data "

Cancer. 2009 Jul 1;115(13 Suppl):3039-45. Development

of a prostate cancer metagram: a solution to the dilemma of which prediction

tool to use in patient counseling.

Nguyen CT, Kattan MW. Glickman Urological and Kidney

Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Many treatment options are available to the human

with clinically localized prostate cancer, including surgery, radiation, and

even active surveillance. To the authors' knowledge, there is no consensus on

the optimal management of this patient population, with most clinicians tending

to recommend the treatment with which they are most familiar. Effective patient

counseling allowing informed decision making can be best achieved with a

formalized system that offers accurate predictions of outcomes for all

available treatment approaches.

The authors organized the currently available

prostate cancer prediction tools toward the formation of a metagram that can be

used to tailor management to the individual patient. A comprehensive review of

the literature was performed to identify published prediction tools intended

for use in prostate cancer. Tools were categorized by a combination of

treatment modality and the outcome being predicted, and incorporated into a

metagram constructed of 16 different treatment options and 10 outcomes related

to cancer control, survival, and morbidity.

A search of the literature revealed 44 prostate

cancer prediction tools that assessed at least 1 of the 160 treatment/outcome

combinations that comprise the metagram. Only 31 cells of the metagram were

populated with currently available tools. Prediction tools offer the most

accurate estimates of outcomes in prostate cancer, but their current role in

patient counseling is complicated by the large number of existing tools, as

well as a lack of comparative data. To address this, the authors incorporated

the most relevant prediction tools currently available into a prostate cancer

metagram that may offer evidence-based and individualized predictions for

multiple endpoints after all available treatment options in clinically

localized prostate cancer.

The metagram also reveals areas of deficiency in the

current catalog of prediction tools. Many more prediction tools are needed.

Cancer 2009;115(13 suppl):3039-45. © 2009 American Cancer

Society. PMID: 19544545 [PubMed - indexed for MEDLINE]