Algorithms, nomograms and the detection of indolent prostate cancer.

PURPOSE: Prostate cancer is the most commonly diagnosed cancer in men. However, only about 12% of the men diagnosed with prostate cancer will die of their disease. RESULT: The serum PSA test can detect prostate cancers early, but using a PSA based cut-off indication for prostate biopsy results in unnecessary testing in app. 75-80% of the men and perhaps even more important the serum PSA test cannot tell how aggressive the cancer is. To decrease unnecessary testing different test results are often combined, converted into a probability and displayed graphically. There are more than 40 of these so called nomograms in the case of prostate cancer. These nomograms can be divided into two categories, namely those that predict biopsy outcome using results from serum determination(s) or non-invasive tests such as the DRE and TRUS. The second category represents those nomograms that predict tumor characteristics and prognosis using information coming from pathology review.
CONCLUSION: The ultimate nomogram able to predict tumor characteristics and progression purely based on non-invasive testing will for a large part put an end to the negative side effects and uncertainties that coincide with the early detection of prostate cancer, if it will ever be made.