In the field of prostate cancer, many nomograms are available, but, what is your real-life experience with these tools?
My opinion is that nomograms, used for example in therapeutic planning, are of big help.
I generally employ "Chun Nomogram"in proposing prostate biopsy, expecially with patient worried by complication rate, or, on other side, by PSA value. Before performing radical prostatectomy, Briganti nomogram is useful in planning lymphadenectomy. This proedure is not complication-free, and choosing guided by this nomogram is useful also by "forensic" point of view.
I agree. Nevertheless, I think it may be a little bit "tricky" to use nomograms with some patients.
Do you use them as mean of comparison of different outcomes depending on the choice ?
Second question :
Do we really let the patient choose ? Or is this a way to delegate our responsibility to the patient himself ?
Nice debate.
In my experience, we are often request to give a "second opinion". Nomograms are useful to suggest, to confirm or to disprove opinions. I'm used to employ them, for example, in proposal of "minimally invasive" approach. Example: nomogram proposed by Budaeus et coll in 2010 is useful about brachytherapy in relationship to Gleason Sum Upgrade.
Also in proposal on adjuvant radiotherapy, Steuber et coll, in 2006 give us a nice tool to understand the risk of local recurrence after surgery.
So, I can say that I'm used to employ them also to compare different approaches.
Second answer (but strongly related to the first one):
free access to information and the possibility of different choices (in particular on prostate cancer that's dramatically true) make the proposal of a therapy or a diagnostic tool not a "choice for the patient", but a "choice with the patient". In this contest, a scientific approach I think is to appreciate. Nomograms give us and patients information to make a supported choice. I don't think is a responsability delegation, rather an improvement in awareness of patients.
Can help crystalise statistics for patients, but need caution - does the nomogram apply to this patients situation? Often selected cohort of patients used in developing nomogram - refer review attached
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