Alan W. Partin, M.D., Ph., D.
A Visit with Dr. Alan Partin
by Gerald Couzens
The transition from Dr. Walsh to our new director of the Johns Hopkins department of urology and the Brady Urological Institute couldn’t have been smoother. Alan W. Partin M.D., Ph.D., Professor of Urology at Johns Hopkins, officially took over from Dr. Walsh in December. Dr. Partin is a busy prostate cancer surgeon and performs upwards of 200 radical prostatectomies a year. He has both a basic science and clinical interest in prognosis prediction for men with prostate cancer. Like Dr. Walsh, he is a dedicated scientist. Over the years, he has focused his scientific attention on development and testing of new and existing methods for predicting the aggressiveness of prostate cancers so that rational treatment decisions can be made by both patients and physicians.
Dr. Partin is one of the lucky people who know early on that they want to be scientists. As far back as high school, he always had a keen interest in biology, chemistry, and physics. Switching his medical focus from animals—he originally wanted to be a veterinarian—to humans in his second undergraduate year at the University of Mississippi, he continued his work in his own laboratory at the university and worked with one of his chemistry professors on high-level radiation problems.
Dr. Partin later completed a combined M.D./Ph.D. program at Johns Hopkins and it was here that he first came under the sway of Don Coffey, his mentor, now colleague and friend. “I started medical school wanting to be a pediatrician,” recalled Dr. Partin recently. “I was the guy in anatomy class who never wanted to touch the cadaver. I would be happy just reading the textbook on the topic. I had absolutely no interest in surgery. However, that all changed when Don Coffey lectured to first year medical students. I knew right away I had to work with him. He eventually brainwashed me into becoming a urologist.
“My thesis work with Don Coffey was how cells moved around in people. We found out that prostate cancer cells that did the jitterbug and danced around within the body had a higher ability to become metastatic and spread compared to those cells that were fairly inert and doing the minuet. I certainly learned a lot under Don’s tutelage. By the time I graduated from medical school in 1989, I had 50 manuscripts in peer-reviewed publications, seven book chapters, and I was looked upon as a leader in the field of prostate cancer.”
Dr. Patrick Walsh was also a major influence on Dr. Partin’s medical and scientific path. “One of the first projects I did with Dr. Walsh started one day when I was in the clinic seeing patients with him. Dr. Walsh was teaching me how to examine prostates and determine the stage of cancer. He told me that if the nodule in the prostate felt a certain size, we called it one name but if it felt a little larger, we called it something else. I looked at him and said, “Don’t you think it would make more sense if, instead of coming up with descriptive names we actually figured out what percentage of the prostate the nodule actually took up? That might give us more important information about the tumor. For example, if you had a ping pong ball inside a watermelon, that’s not half as bad as a ping pong ball within a tennis ball.”
“Dr. Walsh looked at me and asked if I thought I could prove that. This was the first of what turned out to be the first of many projects we were to work on together over the years. Our paper came out in 1989 in the Journal of Urology (Partin AW, Epstein JI, Cho KR, Gittelsohn AM, Walsh PC: Morphometric measurement of tumor volume and percent of gland involvement as predictors of pathological stage in clinical stage B prostate cancer.). To this day, it is one of the most referenced papers in the history of urology.
“With this work, we proved two important things: that the percentage of the prostate gland that has cancer in it is more of a predictive probability than the actual size of the nodule; and second, that as a tumor enlarges, it actually makes less PSA.
“Dr. Walsh is a scientist and he always kept a detailed database of all the cancer patients he operated on,” said Dr. Partin. “He kept track of every piece of clinical information. I started to do the same with my own patients. Over the years that important database has allowed us to make all of the important prostate discoveries that we have.”
The name Partin may be somewhat familiar to you already because of your use of the Partin tables, the diagnostic prostate cancer nomograms that Dr. Partin developed in 1993 to help prostate cancer patients get an accurate prediction of their likelihood of being cured.
A nomogram is a device or computer model that uses an algorithm or mathematical formula to predict the probability of an outcome. In describing this important nomogram, one noted medical oncologist said the Partin tables were the “prognostic paradigm of the 1990s.”
“Looking back,” said Dr. Partin, “these tables have allowed us to help the most people possible. Unlike what is being done with so many pieces of intellectual property today, we didn’t commercialize the tables or copyright them. Our goal from the start was to help people make important decisions about their health. We wanted to make the tables available to everyone, spreading them as far and wide as we could. Every patient, doctor, and medical student the world over now looks at the tables to see what the probable cancer prognosis is as soon as a diagnosis is made. The tables are updated every three years. Even though there are now dozens of predictive nomograms now available, the Partin tables remain the standard.”
How will Dr. Partin do as director of the top-rated urology department in the country? Very well, I assure you. It’s actually the job he wanted ever since he came to Hopkins more than two decades ago as a medical student. “Once I joined the department, I knew being head of the department was what I wanted,” said Dr. Partin. “It is quite an honor when I realize that I am only the fourth person to sit in this chair in the department. Dr. Hugh Hampton Young started it all at Johns Hopkins and he was the first urologist in the country. Of course, I feel daunted. However, I wake up every morning ready and willing to take every challenge that comes my way. I am young enough and have enough energy to bring about change and make things happen here.”
Dr. Partin sketched out his ambitious five- to 10-year plan that he hopes will solidify Hopkins not only as a place to meet men’s urological needs, but the needs of women as well. “There is no reason a patient should ever come to Hopkins and be sent away because we don’t have something we can offer them. We are the best at surgery, we have a superb radiation oncology department, and our medical oncology is the best. We should be able to offer every man and woman that walks through our door, some type of effective treatment to take care of their needs.
“One of the first initiatives was to set up our brachytherapy program with Dr. Theodore DeWeese, Chairman of the Department of Radiation Oncology and Molecular Radiation Science. We now offer radioactive seeds to those who choose it as their therapy of choice for prostate cancer and we already have treated several patients.
“We are also working on a protocol so that men with high risk advanced disease come to Johns Hopkins, they will get multi-modal therapy consisting of chemotherapy up front, followed by surgery or radiation as a combined effort to try and treat the disease. We have had nothing like this before to treat disease and Dr. Michael Carducci, Co-Director of the Drug Development Program at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, is working with me on that.
In addition, we have begun a nationwide search for an expert in kidney and bladder stones, as well as for a top person in the treatment of prostatitis and cystitis. We are going to bring these experts to Johns Hopkins and support them in their research and treatment efforts.
“Following up on the groundbreaking work of Drs. Bill Nelson, William Isaacs, and Angelo DeMarzo on the inflammatory link to prostate cancer, I am also going to hire a clinician who treats inflammatory diseases in the prostate.
“The goal behind this effort is to link early clinical changes that we are beginning to see in patients with the prostate-specific genes. Our goal is earlier and more effective treatment of these patients who eventually develop prostate cancer.”
Everyone at the Brady Urological Institute applauds the appointment of Dr. Partin and we look forward to working together in what will surely come to be known as the Partin Years at Johns Hopkins.