Published by the Hamburg group in 1998, this decision process (nomogram...decision table) can be used to preoperatively predict cases at low (2.5%) risk for pelvic lymph node metastasis from prostate cancer...avoiding the need for pelvic node dissection (unless they "look" intra-operatively positive at the time of RRP surgery). [I suppose that the algorithm could apply to radiation port designs, questions of doing seeds or not, and whether to use IMRT or not.] Epstein (Johns Hopkins), et. al., tested this stratification system on 443 of their cases to validate the algorithm².

Risk stratification is based on the detailed pathological analysis of at least a sextant core sampling of the gland. The idea is to assign a status for each of the gland's sextants (I would assume that when greater than 6 cores are taken in a patterned fashion, one could reduce the information to each of the 6 sextant zones). 

So, in order to use this algorithm, the surgical pathology report must detail the Gleason score for each cancerous biopsy.

• low risk group: 0/6 biopsies with dominant Gleason 4 (4+3=7) or worse...no cancerous biopsy with worse than Gleason 3. [2.5% chance of node positivity]
• intermediate risk group: 1-3 of 6 biopsies with dominant Gleason 4 (4+3=7) or worse. [20% chance of node positivity]
• high risk group: 4 or more of 6 having any Gleason 4 pattern. [44.4% chance of node positivity]

References:

1. CAP TODAY November 2002, page 100 (and online at CAP website). [abstracting ref. #2]
2. Haese A, Epstein JI, Huland H, and Partin AW, "Validation...", Cancer 95(5):1016-1021, 1 Sept. 2002.
3. Conrad S, et. al., "Systematic...", J. Urology 159:2023-2029, 1998.
4. Conrad S, et. al., "Prospective Validation...", J. Urology 167:521-525, 2002.

(posted 1 December 2002; updated 11 June 2003)