Sunnybrook researchers developed and validated the nomogram with 3,108 Canadian men including a subset of 408 volunteers with normal PSA (prostate specific antigen) levels who underwent a prostate biopsy. Of the 3,108 men, 42 percent were diagnosed with prostate cancer. The nomogram was shown to perform better than conventional screening with PSA and DRE (digital rectal exam) alone, especially for patients with a known normal PSA level. Among the 408 men with a normal PSA, 24 percent were diagnosed with prostate cancer. Further evaluation of the nomogram is underway with a multi-institutional, cross-Canada study group of another 5,000 men.

At age 70, Colin Graham's PSA level was considered normal (less than or equal to 4.0 ng/ML). When the nomogram was used to assess all his risk factors, Dr. Nam recommended a prostate biopsy. The biopsy diagnosed aggressive prostate cancer and Colin underwent immediate and successful treatment through surgery. "I cannot express enough the relief I felt, knowing things were caught in time," says Graham, "and though this cancer was removed successfully, because I know my risk, Iam also aware I still need to be monitored."

"In Colin's case, though his PSA was normal, a biopsy was justified based on the nomogram. On the one hand, in the case of an older patient with a high PSA level, if the nomogram predicts a low chance of having aggressive prostate cancer, then it would be reasonable to forego a biopsy," says Dr. Nam, assistant professor, department of surgery, University of Toronto.

Unlike current prostate cancer nomograms, this nomogram evaluates the risk of having prostate cancer in patients undergoing PSA screening. Known risk factors and tumour markers used are age, family, history of prostate cancer, ethnicity, urinary symptoms, PSA, free:total PSA ratio, and DRE (performed by the primary care physician). The Sunnybrook Prostate Cancer Risk Calculator is best used in collaboration with an individual's primary care physician. If a patient determines he is at risk for aggressive prostate cancer, he can discuss management and treatment options in consultation with his primary care physician.

Available online at http://www.sunnybrook.ca/programs/occ/prostaterisk/nomogram van Sunnybrook Prostate Cancer Risk Calculator van The is

Prostate cancer is the most common cancer among Canadian men. In 2007, 22,300 men will be diagnosed with prostate cancer. On average, 83 Canadian men will die of prostate cancer every week.