Updated Partin tables may offer improved accuracy

The third and most recent update of the Partin tables takes into account an updated Gleason scoring system and may be more accurate for contemporary patients diagnosed with prostate cancer, researchers from Johns Hopkins University, Baltimore report.

The updated tool, based on a study of more than 5,600 men treated at The Johns Hopkins Hospital from 2006 to 2011, is published in the British Journal of Urology International (2013; 111:22–29). The Partin nomogram, a statistical model to show the probability that cancer is organ confined and likely to be cured with surgery, is based on a patient’s PSA level, Gleason score, and clinical stage.

"The updated Partin tables will significantly improve the ability of physicians to counsel patients on the extent of their disease and help them make treatment decisions, such as whether surgery is warranted and, if so, whether lymph nodes also should be removed during surgery,” said study co-author Alan W. Partin, MD, PhD, creator of the tables.

The new nomogram shows that certain categories of men who were previously not thought to have a good prognosis actually could be cured with surgery, said lead author John B. Eifler, MD. "We now have a better understanding of intermediate risk and see that more men now fall into that category, instead of the higher risk group," Dr. Eifler said.

For example, men with a biopsy Gleason score of 8 and above previously were not thought to be good candidates for surgery because of the likelihood that the cancer had spread. The new data show a higher probability of a cure with surgery even if a man’s Gleason score is 8.

Specifically, study results showed:

• The median PSA was 4.9 ng/mL, 63% of men had Gleason 6 disease, and 78% had T1c disease.

• 73% of patients had organ-confined disease, 23% had extraprostatic extension, 3% had seminal vesicle involvement but not lymph node involvement, and 1% had lymph node-positive disease. Compared to the previous Partin nomogram, there was no change in the distribution of pathologic stage.

• 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 lymph node-positive disease and may have lymphadenectomy omitted at radical prostatectomy.

The updated Partin tables are available at urology.jhu.edu/prostate/partintables.php.