Factors needed to work the nomogram: patient's age, total serum PSA value, whether the pathologist is highly experienced at reading prostate core biopsies (uro-path) or not (other), whether urologist's DRE exam of patient is normal or not, whether biopsies contained any PIN or not, the prostate volume by TRUS calculation, whether TRUS exam found any hypoechoic areas (positive) or not (negative), whether the biopsies were taken in a "sextant" 6-core procedure (systematic) or an extended series (more than six biopsies) procedure, and the sum of all cancer segments divided by the sum of lengths of all the biopsy cores (to calculate CA Percentage). For each factor point/value, bring a vertical line upward to the  "points" line and note the value where the lines intersect. Finally, sum the points for each factor and plot that sum on the lower "total points" line. from that sum point, drop a vertical line to the "probability" line below in order to see the probability that your case would contain Gleason upgrade if the whole prostate were examined.