They have been called the next best thing to virtual surgery. The Partin Tables were developed by Alan Partin, M.D., Ph.D., Director of the Brady Urological Institute, and The David Hall McConnell Professor in Urology, and Patrick C. Walsh, M.D., University Distinguished Service Professor of Urology, after they studied the course of prostate cancer in hundreds of Walsh's radical prostatectomy patients at first, and later expanded to include thousands of men who underwent radical prostatectomy at Johns Hopkins. These tables use clinical features of prostate cancer – Gleason score, PSA level in the blood, and clinical stage – to predict whether a man's tumor will be confined to the prostate. For decades, they have helped men and their doctors worldwide to predict the definitive pathological stage before treatment, so they can determine the treatment that is best for them. Over the years, the Tables have been updated to reflect the improvement in cancer control that has come in the "PSA era" with increasingly earlier diagnosis. Today, most men are diagnosed with a lower PSA , lower clinical stage, and higher likelihood of harboring organ-confined tumors than men diagnosed with prostate cancer in the pre-PSA era, before 1992.
In these updated Tables, the findings came from 5,629 consecutive men who underwent radical prostatectomy and staging lymphadenectomy at Johns Hopkins between 2006 and 2011. The results were published in the British Journal of Urology–International (BJUI) and will be available for men and urologists worldwide, including on the Brady website. Taking part in this research were John Eifler, Zhaoyong Feng, Brian Lin, Michael Partin, Elizabeth Humphreys, Misop Han, Jonathan Epstein, Patrick Walsh, Bruce Trock, and Alan Partin.
"It has been very interesting to see how, since PSA screening was introduced in the early 1990s, the extent of disease for men with prostate cancer has slowly changed over time and now seems to have stabilized," notes Partin. "Also, subtle changes to the Gleason scoring system, (which narrow the scope of Gleason pattern 3 and widen the scope of Gleason pattern 4) have made the system more accurate, and these were not considered in previous editions of the Tables."
Good news: Gleason 8 disease
is more like Gleason 4 + 3 disease.
The recent analysis demonstrated that "most men with Gleason 3+3 disease and many with Gleason 3+4 disease do not require pelvic lymph node removal during radical prostatectomy," Partin continues. "Also, traditionally men with Gleason 8, 9, or 10 disease have been considered high risk, though we found that men with Gleason 8 disease were closer in the extent of their tumor to men with Gleason 4+3 disease, rather than men with Gleason 9 and 10." Men with Gleason 8 disease, he adds, were much less likely to have lymph node involvement than men with higher Gleason scores. This is good news; in the past, men with Gleason 8, 9, and 10 disease all tended to be lumped into the same category.
"Clinicians should use these updated tables when counseling patients on the extent of their disease, and to help determine who would likely benefit from removing the lymph nodes during radical prostatectomy."
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