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Updated Nomogram To Predict Pathologic Stage Of Prostate Cancer Given PSA, Clinical Stage, and Biopsy Gleason Score (Partin Tables) Based On Cases From 2000-2005
Danil V Makarov, Bruce J. Trock, Elizabeth B. Humphreys, Leslie A. Mangold, Patrick C. Walsh, Jonathan I. Epstein, Alan W. Partin
Johns Hopkins University School of Medicine, Baltimore, MD
Objectives: We presented nomograms combining preoperative serum prostate-specific antigen (PSA), clinical stage, and biopsy Gleason score to predict final pathologic stage at radical prostatectomy. The effects of stage migration are demonstrable since 2001; increasing numbers of men present with non-palpable, lower grade cancer and lower PSA values. We update the 2001 “Partin Tables” with a contemporary patient cohort and revised variable categorization.
Methods: We analyzed 5,734 men treated with prostatectomy (without neoadjuvant therapy) between 2000 and 2005 at the Johns Hopkins Hospital. Average age was 57 years. Multinomial logistic regression was used to estimate the probability of organ-confined disease, extraprostatic extension, seminal vesicle involvement, or lymph node involvement. Predictor variables included preoperative PSA (0-2.5, 2.6-4.0, 4.1-6.0, 6.1-10.0, and >10ng/mL), clinical stage (T1c, T2a, and T2b/T2c), and biopsy Gleason score (5-6, 3+4=7, 4+3=7, or 8-10).
Results: 77% had T1c, 76% had Gleason 6, 80% had PSA between 2.5-10.0ng/mL, and 73% had organ-confined disease. Nomograms were developed of the predicted probability of pathologically organ-confined disease, extraprostatic extension, or the combination of seminal vesicle or lymph node involvement. Ninety-five percent confidence intervals were developed using bootstrap resampling. The risk of non-organ-confined disease increased with increases in any individual prognostic factor. Combining T2b with T2c groups generated better predictive accuracy.
Conclusions: These updated “Partin Tables” were generated to reflect trends in presentation and pathologic stage for men diagnosed with clinically localized prostate cancer at our institution. Clinicians and patients can use these nomograms to help make important decisions regarding management of prostate cancer.
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