The Prognostic Index

The Prognostic Index is a stratification system which combines the predictive power of histological grade, anatomical level of infiltration, and perineural invasion to define three distinctive groups of patients with different risks for nodal metastasis. The Index is constructed by adding up numerical values assigned to histological grade (1 point for grade 1, 2 points for grade 2, and 3 points for grade 3 tumors), anatomical level of infiltration (1 point for tumors invading up lo lamina propria,

2 points for invasion of corpus spongiosum/preputial dartos, and 3 points for invasion of corpus cavernosum/preputial skin), and perineural invasion (0 points if absent and 1 point if present). A score, ranging from 2 to 7, is obtained. Patients with scores 2 and 3 are at low risk for nodal metastasis and, in the absence of clinical evidence of nodal involvement, a surveillance program should suffice for them. Patients with scores 5, 6, and 7 are at high risk for nodal metastasis and should receive a prophylactic groin dissection, regardless of the clinical status of the inguinal nodes. Patients with score 4 are problematic to handle and other procedures, such as imaging studies and dynamic sentinel lymph node biopsy, should be used to better define the likelihood of inguinal metastasis.

Dealing With Erectile Dysfunction

Dealing With Erectile Dysfunction

Whether you call it erectile dysfunction, ED, impotence, or any number of slang terms, erection problems are something many men have to face during the course of their lifetimes.

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