Please can you give a brief introduction to prostate cancer?
Prostate cancer is the most common cancer in men. Despite many advances in diagnosis and treatment over the past two decades, it remains the second most common cause of cancer related death in men.
Prostate cancer may be suspected based on an abnormal rectal exam or blood test (PSA). If so, a prostate biopsy is typically performed to assess whether cancer is present, and if so, how aggressive it appears under the microscope as measured by the Gleason scoring system (higher Gleason score denotes more aggressive disease).
How many men does prostate cancer affect?
In the United States, over 240,000 men will be diagnosed with prostate cancer this year. Approximately 1 in 6 men will be diagnosed during their lifetime.
Nearly 30,000 men will die of prostate cancer this year, though most men diagnosed with prostate cancer will never die of the disease.
What are the Partin Tables?
The Partin Tables use the results of the rectal exam, the PSA level, and the Gleason score, to predict the likelihood that cancer is still confined to the prostate, when it is most amenable to cure, and how likely it is to have spread into the genital tract (the seminal vesicles) or to adjacent lymph nodes.
When and why were the Partin Tables created?
The Partin Tables were initially reported in 1993 by Dr. Alan Partin based on thousands of men who underwent “nerve-sparing” radical prostatectomies by Dr. Patrick C. Walsh.
The Partin Tables were intended to counsel men diagnosed with prostate cancer about the likely status of their disease and possible treatment options.
For clinicians, the Partin Tables helped to determine which men could likely be cured by surgery and which were better served by other treatment modalities.
Why did the Partin Tables need revising?
Over time, due to widespread PSA testing in the United States, men are diagnosed earlier in the disease process than ever, often without any evidence of prostate cancer on rectal exam.
As a result, the Partin Tables need to evolve to reflect the contemporary man facing a new diagnosis of prostate.
Also, the Gleason scoring system, which rates how aggressive prostate cancer appears under the microscope, was modified in 2005, and the current tables incorporate these modifications.
Dr Alan Partin: "The presentation of men with prostate cancer has changed over the decades as we better utilize our armament of tests and exams. We have updated the Partin Tables over this period in an attempt to keep up with the changes - we hope the new tables will continue to help Physician's and patients make the important decisions when diagnosed with prostate cancer. "
In what ways have the Partin Tables been changed?
In this update, men with Gleason 8 disease, which was traditionally considered to have “high risk” disease, were seen to be more similar to men with “intermediate risk” disease than to men with Gleason 9-10 disease.
Also, the updated Tables suggest that most men with Gleason 6 disease are very unlikely to have disease that spread to the draining lymph nodes, and removal of these lymph nodes during surgery is often unnecessary.
Are the Partin Tables now more accurate?
The updated Partin Tables are expected to be more accurate for men diagnosed with prostate cancer today.
What impact do you think the revised Partin Tables will have?
The Tables should serve as a tool urologists use to counsel men newly diagnosed with prostate cancer about the likelihood their disease is still confined to the prostate.
It will also assist urologists in determining which men undergoing surgery should have their lymph nodes removed at the time of surgery.
What do you think the future holds for prostate cancer spread prediction?
New imaging tools (e.g. MRI) and screening tests are being tested to see if they improve our ability to predict the extent of prostate cancer.
As this research matures, this information may be incorporated in future predictive tools.
Where can readers find more information?
The Johns Hopkins Urology website provides a Partin table calculator that men can use and discuss with their physicians: http://urology.jhu.edu/prostate/partintables.php
About John B. Eifler, M.D.
John Eifler is a urology resident at the prestigious Brady Urological Institute of Johns Hopkins.
He graduated from the University of Kentucky Summa Cum Laude and the Weill Cornell Medical College in New York City prior to matriculating at Johns Hopkins.
He participated in the highly competitive Howard Hughes Medical Institute Research Scholars program at the National Institutes of Health during medical school and solidified his interest in urologic oncology.
During his residency, he was awarded a grant from the National Kidney Foundation to study fluorescent imaging agents which may be useful in identifying prostate cancer during surgery.
At the conclusion of his residency, John will pursue subspecialty urologic oncology training at Vanderbilt University Medical Center.