Decision Support for Low-Risk Prostate Cancer
Since the introduction of prostate-specific antigen for the early detection of prostate cancer, overdiagnosis and subsequent overtreatment have become more and more apparent. Conservative treatment options, specifically active surveillance, are therefore becoming increasingly used in an attempt to reduce the morbidity of radical treatment. Several clinical prediction models were developed to assess an individual's risk of having indolent prostate cancer. Those with high probabilities of indolent cancer are best suited for conservative management. Prediction models readily provide detailed risk estimates when presented as nomograms, which is preferable over simpler presentations as rules. Incorporation of prediction models into decision aids is a good way of providing the best of care for men facing a treatment decision of low-risk prostate cancer with improved patient knowledge and more conscious treatment choices. In this chapter, different currently available nomograms are discussed, with considerations to select the most appropriate nomogram for an individual patient.