Nomogram use for the prediction of indolent prostate cancer

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Abstract
BACKGROUND Screening for prostate cancer has resulted in an increased incidence‐to‐mortality ratio. Not all cancers deserve immediate treatment. It has therefore become more important to be able to identify those cases of screen‐detected prostate cancer most likely to show indolent behavior. METHODS The Kattan‐nomogram for the prediction of indolent prostate cancer was validated and recalibrated for use in a screening setting. The recalibrated nomogram was used to calculate the number of men who were predicted to have indolent cancer in a screen‐detected cohort from the European Randomized study of Screening for Prostate Cancer (ERSPC), section Rotterdam. RESULTS Of 1629 cancers detected in 2 subsequent screening rounds 825 were suitable for nomogram use. The remainder were very unlikely to have indolent cancer. A total of 485 men (485 of 825 = 59%) were predicted to have indolent cancer, which is 30% (485 of 1629) of all screen‐detected cases. Cancers found at repeated screening after 4 years had a higher probability of indolent cancer than cases from the prevalence screening (44% vs 23%; P < .001). CONCLUSIONS The current nomogram can identify substantial groups of screen‐detected cancers that are likely indolent and can therefore be considered for active surveillance. Cancer 2007. © 2007 American Cancer Society.