The 1997 JAMA Abstract:
Combination of prostate-specific antigen, clinical stage,
and Gleason score to predict pathological stage of localized prostate
cancer. A multi-institutional update.
Source: JAMA [Journal of the American Medical Assn.]277(18): 1445-51, 1997
Partin AW, Kattan MW, Subong EN, Walsh PC, Wojno KJ, Oesterling JE, Scardino
PT, Pearson JD.
Department of Urology, Johns Hopkins Hospital, Baltimore, MD, 21287-2101,
OBJECTIVES: To combine the clinical data from 3 academic institutions
that serve as centers of excellence for the surgical treatment of clinically
localized prostate cancer and develop a multi-institutional model combining
serum prostate-specific antigen (PSA) level, clinical stage, and Gleason
score to predict pathological stage for men with clinically localized
DESIGN: In this update, we have combined clinical and pathological
data for a group of 4133 men treated by several surgeons from 3 major
academic urologic centers within the United States. Multinomial log-linear
regression was performed for the simultaneous prediction of organ-confined
disease, isolated capsular penetration, seminal vesicle involvement, or
pelvic lymph node involvement. Bootstrap estimates of the predicted probabilities
were used to develop nomograms to predict pathological stage. Additional
bootstrap analyses were then obtained to validate the performance of the
PATIENTS AND SETTINGS: A total of 4133 men who had undergone radical
retropubic prostatectomy for clinically localized prostate cancer at The
Johns Hopkins Hospital (n=3116), Baylor College of Medicine (n=782), and
the University of Michigan School of Medicine (n=235) were enrolled into
this study. None of the patients had received preoperative hormonal or
OUTCOME MEASURES: Simultaneous prediction of organ-confined disease,
isolated capsular penetration, seminal vesicle involvement, or pelvic
lymph node involvement using updated nomograms.
RESULTS: Prostate-specific antigen level, TNM clinical stage,
and Gleason score contributed significantly to the prediction of pathological
stage (P<.001). Bootstrap estimates of the median and 95% confidence
interval of the predicted probabilities are presented in the nomograms.
For most cells in the nomograms, there is a greater than 25% probability
of qualifying for more than one of the pathological stages. In the validation
analyses, 72.4% of the time the nomograms correctly predicted the probability
of a pathological stage to within 10% (organ-confined disease, 67.3%;
isolated capsular penetration, 59.6%; seminal vesicle involvement, 79.6%;
pelvic lymph node involvement, 82.9%).
CONCLUSION: The data represent a multi-institutional modeling
and validation of the clinical utility of combining PSA level measurement,
clinical stage, and Gleason score to predict pathological stage for a
group of men with localized prostate cancer. Clinicians can use these
nomograms when counseling individual patients regarding the probability
of their tumor being a specific pathological stage; this will enable patients
and physicians to make more informed treatment decisions based on the
probability of a pathological stage, as well as risk tolerance and the
values they place on various potential outcomes.