THE PARTIN TABLES

Introduction

Danil V. Makarov, Bruce J. Trock, Elizabeth B. Humphreys, Leslie A. Mangold, Patrick C. Walsh, Jonathan I. Epstein, and Alan W. Partin

            The "Partin tables" were originally developed by urologists Alan W. Partin, M.D., Ph.D., and Patrick C. Walsh, M.D. based on accumulated data from hundreds of patients who had been treated for prostate cancer.

Ingeniously correlating the three things that were known about a man's disease -- PSA level, Gleason score, and estimated clinical stage -- the tables were designed to help men and their doctors predict the definitive Pathological Stage (determined after surgery, when a pathologist examines the removed prostate for the presence of cancer) and best course of treatment.

Now the tables have been updated with the knowledge gained from having treated thousands of patients, to reflect the trends in presentation and pathologic stage for men newly diagnosed with clinically localized prostate cancer at James Buchanan Brady Urological Institute.  Clinicians can use these nomograms to counsel individual patients and help them make important decisions regarding their disease.

Nomograms predicting pathologic stage of CaP based on clinical stage (TNM), PSA, and Gleason score

RESULTS
       

5,730 men, average age 57.4±6.4 years (range 34-75), meeting the eligibility criteria were consecutively enrolled.  89% were Caucasian and 7% African-American.  The final Pathologic Stage demonstrated 73%, 22%, 3%, and 1% had OC, EPE, SV+, or LN+, respectively.

As in our previous nomograms,^1-3 PSA, GS, and Clinical Stage contributed significantly to prediction of Pathologic Stage using multinomial logistic regression.  The combination of three preoperative variables predicted Pathologic Stage better than any single variable individually.  The predicted probabilities from the multinomial logistic regression analysis and bootstrapped 95%CIs are presented in the Table. The numbers within each cell of the nomogram represent the predicted probability of a given Pathologic Stage based on regression from three preoperative variables. For example, a man with preoperative PSA=2.7ng/mL, GS3+3=6 and a nonpalpable (T1c) DRE has predicted probabilities of 88%OC, 11%EPE, 1%SV+, and a negligible risk of LN+. A man with PSA=11.4ng/mL and GS8 with a large palpable tumor (T2c) has predicted probabilities of only 12%OC, 33%EPE, 28%SV+, and 26%LN+.

Risk of EPE, SV+ and  LN+ each increased significantly with successively higher PSA, Clinical Stage, or GS (p<0.001).  An exception occurred comparing Pathologic Stage between GS4+3 and GS8-10.  Regardless of Clinical Stage or PSA, men with GS8-10 had a slightly higher predicted probability of OC, and similar or slightly lower probability of LN+, although these trends were not statistically significant (p=0.90 and 0.77, respectively).  Another exception was a lack of significant difference in risk of SV+ or LN+ between PSA 0-2.5 and 2.6-4.0 (p=0.507).  This may reflect the small numbers of these Pathologic Stage amongst men with low PSA (n=19).  A similar lack of association between SV+ or LN+ has been observed between PSA 2.6-4.0 and 4.1-6.0 in men undergoing RP.⁴

COMMENT
           

As a result of changed CaP biology or improved detection, men presenting with CaP today are increasingly likely to have OC.⁵  This stage migration must be accounted for in models predicting the behavior of CaP for contemporary patients.  We have used data from 5,730 patients treated between 2000-2005 to develop an updated nomogram Partin Tables, using preoperative PSA, Clinical Stage, and GS to provide the estimated probability of various final Pathologic Stage at RP.  Because this stage migration resulted in few surgical candidates (0.6%) with Clinical Stage T2c, we found that combining T2b/T2c into a single group generated a model that may have greater validity for use in other populations.

CONCLUSIONS
 

These updates and improvements should make this model more useful to clinicians and patients.
           

1. Partin AW, Kattan MW, Subong EN, Walsh PC, Wojno KJ, Oesterling JE, Scardino PT and Pearson JD: Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. Jama. 277: 1445-51, 1997.
   

2. Partin AW, Mangold LA, Lamm DM, Walsh PC, Epstein JI and Pearson JD: Contemporary update of prostate cancer staging nomograms (Partin Tables) for the new millennium. Urology. 58: 843-8, 2001.
   

3. Partin AW, Yoo J, Carter HB, Pearson JD, Chan DW, Epstein JI and Walsh PC: The use of prostate specific antigen, clinical stage and Gleason score to predict pathological stage in men with localized prostate cancer. J Urol. 150: 110-4, 1993.
   

4. Makarov DV, Humphreys EB, Mangold LA, Walsh PC, Partin AW, Epstein JI and Freedland SJ: Pathological outcomes and biochemical progression in men with T1c prostate cancer undergoing radical prostatectomy with prostate specific antigen 2.6 to 4.0 vs 4.1 to 6.0 ng/ml. J Urol. 176: 554-8, 2006.
   

5. Han M, Partin AW, Pound CR, Epstein JI and Walsh PC: Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. Urol Clin North Am. 28: 555-65, 2001.