title: Clinicians versus nomogram: predicting future technetium-99m bone scan positivity in patients with rising prostate-specific antigen after radical prostatectomy for prostate cancer.
abstract: OBJECTIVE
  To compare the ability of clinicians vs a nomogram at predicting future bone scan positivity in patients with prostate cancer.
  
  
  METHODS
  This investigation was conducted during an advisory board meeting in June 2011. Details of 25 androgen deprivation therapy-naive prostate cancer patients were given to 24 prostate cancer experts, including urologists and oncologists. The clinicians were asked to predict the probability that the patients would have a positive bone scan if left untreated for 1 year. These predictions and those of the Slovin nomogram were compared with the actual occurrence of metastatic disease, and the discrimination ability was quantified using the concordance index (C index).
  
  
  RESULTS
  A higher C index value was obtained with the Slovin nomogram (0.812) than with the clinicians (0.628). The nomogram outperformed all of the clinicians; individual clinician C index values varied between 0.47 and 0.75. The urologists provided superior predictions compared with the oncologists.
  
  
  CONCLUSIONS
  Future bone scan positivity can be predicted more accurately using a nomogram than by expert clinicians. Nomograms should, therefore, become an integral part of the clinical decision-making process in the prostate cancer setting for patients with a rising prostate-specific antigen level after radical prostatectomy.
authors: Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. kattanm@ccf.org
authors: Michael W
authors: MW
authors: Kattan
authors: Changhong
authors: C
authors: Yu
authors: Andrew J
authors: AJ
authors: Stephenson
authors: Oliver
authors: O
authors: Sartor
authors: Bertrand
authors: B
authors: Tombal
mesh_terms: D000328:Adult; D000368:Aged; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D005060:Europe / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D049451:Nomograms; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D013667:Technetium; D014481:United States / Q000453:epidemiology
chemical_list: D013667:Technetium; D017430:Prostate-Specific Antigen