A multi-center research team has used data from > 7,300 radical prostatectomy patients treated between 2000 and 2005 at two major medical centers to construct a new “2010 Partin nomogram” to improve prediction of pathologic outcomes after radical surgery.
The current Partin tables (last updated in 2007) use pre-surgical total PSA data to categorize patients into five “risk groups” (with PSA levels of 0-2.5, 2.6-4.0, 4.1-6.0, 6.1-10.0 and >10.0 mg/ml). The new “2010 Partin nomogram” is based on the application of the total PSA level as a “continuous” biomarker to allow the development of a “predictiveness curve” to facilitate more accurate calculation of the risk of a patient for a specific pathologic outcome.
The new nomogram is based on data from 5,730 patients treated at Johns Hopkins Hospital and another 1,646 patients treated at the University Clinic Hamburg-Eppendorf in Germany. All patients received a radical prostatectomy. No patients received any form of neoadjuvant treatment.
Other patient risk factors remain the same, and are based on the patient’s clinical stage T1c, T2a, and T2b/T2c) and biopsy Gleason score (5-6, 3 + 4 = 7, 4 + 3 = 7, 8-10). This information, together with the new PSA “predictiveness curve” can be used to predict probabilities of:
- Organ-confined disease (OC)
- Extraprostatic extension (EPE)
- Seminal vesicle invasion (SV+)
- Lymph node involvement (LN+)
The development of this new Partin nomogram is described in a recent paper by Huang et al. in BJU International. The currently available on-line system for assessing pathologic outcomes is still based on the 2007 Partin tables. We assume that that web site will be updated at some point in the future to take advantage of this revision of the Partin tables to a nomogram-based system. Huang et al. clearly state that this revision will (or at least should) improve the ability of urologists and their patients to make appropriate treatment decisions.
Filed under: Diagnosis, Management, Risk, Treatment | Tagged: nomogram, Partin tables, revision, update |
THE "NEW" PROSTATE CANCER INFOLINK 
If — 23+ years after a radical prostatectomy, with no follow-up treatments necessary — a PSA value of 77 comes back, what would be the next step?
Dear Mr. Matthews:
If I had this happen to me, I would want my doctors to give me a bone scan and a CT scan. This looks like a classic case of delayed recurrence of metastatic prostate cancer that may have metastasized to the bone marrow before your ever had your surgery, and which has now started to grow. A delay of this long in such a recurrence is rare, but I have certainly heard of it happening before.
If the bone scan and the CT scan were both negative (which is possible), I would still want to talk to my doctors about immediate initiation of intermittent androgen deprivation therapy.
Please have them make certain that the result is yours and that they have not mixed up samples. Then have another blood sample drawn and run either at the same lab or another reputable laboratory. THEN the recommendations given above would be appropriate if the result was confirmed.