OC: organ confined;
EPE: extraprostatic extension;
SV + : seminal vesicle involvement;
LN + : lymph node involvement.
The Partin Tables use clinical features of prostate cancer – Gleason score, serum PSA, and clinical stage – to predict whether the tumor will be confined to the prostate. The tables are based on the accumulated experience of urologists performing radical prostatectomy at the James Buchanan Brady Urological Institute. For decades, urologists around the world have relied on the tables for counseling patients preoperatively and for surgical planning.
Since PSA screening was introduced in the early 1990’s, the extent of disease for men with prostate cancer has slowly changed over time. Also, subtle changes to the Gleason scoring system have made the system more accurate but were not considered in previous editions of the Partin tables. Earlier this year, the tables were updated using the experience of surgeons at the Brady performing radical prostatectomy from 2006-2011.
Interestingly, the change in extent of disease seen since PSA testing became commonplace has stabilized, something not previously reported.
The analysis demonstrated that most men with Gleason 3+3 disease and many with Gleason 3+4 disease do not require pelvic lymph node removal during radical prostatectomy. Also, traditionally men with Gleason 8,9, or 10 disease have been considered high risk, though in our analysis Gleason 8 disease had similar tumor extent to Gleason 4+3 rather than Gleason 9-10. Clinicians should use the updated tables when counseling patients on the extent of their disease, and to help determine who would likely benefit from removing the lymph nodes during radical prostatectomy.
An updated prostate cancer staging nomogram (Partin tables)
based on cases from 2006 to 2011
John B. Eifler , Zhaoyang Feng , Brian M. Lin , Michael T. Partin , Elizabeth B. Humphreys , Misop Han , Jonathan I. Epstein , Patrick C. Walsh , Bruce J. Trock and Alan W. Partin
James Buchanan Brady Urological Institute and the Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
INTRODUCTION The ‘Partin tables’ use commonly available preoperative data – serum PSA level, clinical stage and biopsy Gleason score – to predict pathological stage at radical prostatectomy (RP). The original Partin tables used preoperative data from men who were treated between 1982 and 1991; so most were diagnosed in the pre-PSA era [ 1 ] . Updates to the Partin tables refl ected the changing nature of prostate cancer
Accepted for publication 23 March 2012
What' s known on the subject? and What does the study add? Pathological stage after radical prostatectomy can be accurately predicted by serum prostate-specific antigen level, clinical stage and biopsy Gleason sum, the 'Partin tables' . Since the previous publication of the Partin tables, an updated Gleason scoring system has been established and incremental changes have occurred in the clinical characteristics of patients diagnosed with prostate cancer. The current analysis updates the Partin nomogram in a contemporary cohort of patients.
• To update the 2007 Partin tables in a contemporary patient population.
PATIENTS AND METHODS
The study population consisted of 5,629 consecutive men who underwent RP and staging lymphadenectomy at the Johns Hopkins Hospital between January 1, 2006 and July 30, 2011 and met inclusion criteria.
• Polychotomous logistic regression analysis was used to predict the probability of each pathologic stage category: organ-confi ned disease (OC), extraprostatic extension (EPE), seminal vesicle involvement (SV + ), or lymph node involvement (LN + ) based on preoperative criteria.
• Preoperative variables included biopsy Gleason score (6, 3 + 4, 4 + 3, 8, and 9 – 10), serum PSA (0 – 2.5, 2.6 – 4.0, 4.1 – 6.0, 6.1 – 10.0, greater than 10.0 ng/mL), and clinical stage (T1c, T2c, and T2b/T2c).
• Bootstrap re-sampling with 1000 replications was performed to estimate 95% confi dence intervals for predicted probabilities of each pathologic state.
• The median PSA was 4.9 ng/mL, 63% had Gleason 6 disease, and 78% of men had T1c disease.
• 73% of patients had OC disease, 23% had EPE, 3% had SV + but not LN + , and 1% had LN + disease. Compared to the previous Partin nomogram, there was no change in the distribution of pathologic state.
• The risk of LN + disease was signifi cantly higher for tumors with biopsy Gleason 9 – 10 than Gleason 8 (O.R. 3.2, 95% CI 1.3 – 7.6).
• The c-indexes for EPE vs. OC, SV + vs. OC, and LN + vs. OC were 0.702, 0.853, and 0.917, respectively.
• Men with biopsy Gleason 4 + 3 and Gleason 8 had similar predicted probabilities for all pathologic stages.
• Most men presenting with Gleason 6 disease or Gleason 3 + 4 disease have < 2% risk of harboring LN + disease and may have lymphadenectomy omitted at RP. CONCLUSIONS • The distribution of pathologic stages did not change at our institution between 2000 – 2005 and 2006 – 2011.
• The updated Partin nomogram takes into account the updated Gleason scoring system and may be more accurate for contemporary patients diagnosed with prostate cancer. KEYWORDS prostate cancer , prostatectomy , prostagespecifi c antigen , nomograms , staging