The Truth... What is it?

The 2007 Fleshner nomogram

[Dr. Shaw's personal website]

Purpose: an experimental tool to evaluate post-biopsy D'Amico or JUA low-risk cancers...candidates for brachytherapy or watchful waiting (active surveillance) predict from biopsy & clinical parameters the likelihood that findings in a prostatectomy of that case would cause a postoperative  Gleason upgrade (nomogram helps avoid under-treatment by flagging cases for further consideration of advisability of caution about any conservative management option).

NOTE: the nomogram does not know how to "back out" the inflammatory portion of elevated PSA, if the case has significant prostatitis [S07-6946].

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.


We recommend the journal, Cancer, and have placed this graphic on the website in order solely to make it more convenient for our uropathologists to use this nomogram in cases they wish to test.

Dr. Shaw's personal WEB-FILE of info for prostate cancer patients & their "significant others"

Our pathology group's TOC WEB-FILE on prostate cancer issues



et. al. & Fleshner Neil E. (Toronto, Canada), Clinical Predictors of Gleason Score Upgrading, Cancer 109(12):2432-38, June 15, 2007. The nomogram chart is on page 2436.

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(posted 20 December 2007)