Understanding and Using Partin Coefficient Tables
Last Revised May 14, 1997
[NOTE: The tables were updated in June, 2001, but this explanation still serves. The new tables are at the site of Dr. Oppenheimer's pathology lab. He is the author of "Partin Table Predictions: What Do They Really Mean?" here at InfoLink.]
Introduction |
How the Partin tables work |
Example |
Permission
Introduction
The so-called "Partin tables" were originally developed by a group of
urologists at
the Brady Institute for Urology at
Johns Hopkins University based on accumulated data
from hundreds of patients who had been treated at that institution. They
are called "Partin tables" after just one of the original contributors to
this research.
The original Partin coefficient tables were revised in May 1997 based on data
from three major prostate cancer research institutions: Johns Hopkins in
Baltimore, Baylor School of Medicine in Houston, and the Michigan Prostate Institute in
Ann Arbor. In this revision, data accumulated from 4,133 patients treated
by radical prostatectomy were used to carry out the statistical modifications.
[Note: More men have been included with a June, 2001, update. See note at top and bottom.]
The Partin coefficient tables can be used to combine data on the PSA value, the
Gleason score,
and the clinical stage of a specific patient in order to be able to try
and predict
the specific risk of that patient. In using these tables, it is very
important to understand
that the actual clinical value of these tables in predicting outcome for
large numbers of patients has never actually been proved. In other
words, the data which these table offer are increasingly interesting, but
cannot be
absolutely used to specify the prognosis of any particular patient with any
known degree of accuracy. Readers may be interested in
comments on
interpretation of the data in the Partin tables made by Jonathon Oppenheimer, MD,
which appear elsewhere on The Prostate Cancer InfoLink
Having made this comment, Partin and his colleagues have reported that use of
the prior version of the Partin coefficient tables have resulted in the following
improvements in outcome in 1993-1996 compared to the pre-Partin table era (1989-1993)
at Johns Hopkins:
- Percentage of men found to have organ-confined disease at the time
of radical prostatectomy has risen from 33% to 55%
- Percentage of men found to have positive seminal vesicles or positive lymph nodes
decreased from 21% to 10%.
It must be noted that at least a part of the reason for these improvements
can be associated with other factors (such as the increased use of PSA testing
and stage migration secondary to the introduction of clinical stage T1c
as a defined tumor stage).
How the Partin coefficient tables
work
The Partin coefficient tables can be used to offer estimates of four different
items which may be very important in deciding how to treat a patient:
In the various sections in The Prostate Cancer InfoLink on the treatment of
prostate cancer, it will be apparent that these different risks can have significant
impact on how a doctor will offer to treat a patient with prostate cancer,
and also on how a patient may wish to be treated.
The Prostate Cancer InfoLink again emphasizes that the data offered in these
tables are not definitive. Patients are strongly advised to discuss data from
these tables with their physicians and not to rely on these table as strictly
accurate prognostic indicators.
An example of the use of the Partin coefficient
tables
Brian is a 58-year-old man who received a positive standard PSA test of 7.4 ng/ml at
his annual physical examination. There is no family history of prostate
cancer and
there was no indication of a problem on the basis of his DRE.
His urologist repeated the DRE, but still could find no sign of prostate cancer
other than the elevated PSA value. A PSA II or free/total PSA test was
carried out to assess Brian's risk for prostate cancer as compared to his
risk for benign prostatic hyperplasia. This gave a ratio of 0.12 or 12%.
After discussion with Brian, the urologist carried out an ultrasound-guided prostate
biopsy. The biopsy showed two small foci of prostate cancer in one node of
the prostate. The
Gleason score of this prostate cancer was classified by the pathologist as
3 + 4 = 7. The urologist
classified Brian's prostate cancer as clinical stage T1c.
One can use the Partin tables to make the following predictions about Brian's
prostate cancer:
- Using the appropriate table
(based on Brian's PSA of 7.4 ng/ml) to predict the probability of
Brian having organ-confined
(and therefore theoretically curable) disease, we find that this probability
is 49%.
In other words, according to this table, there are about 5 chances out of
10 that Brian's cancer is
not confined within the prostate.
- Using the appropriate
table (based on Brian's PSA of 7.4 ng/ml)
to predict the probability of Brian having established capsular penetration
(and therefore his risk of positive margins if he were to have surgery),
we find that this probability is 40%.
In other words, according to this table, there are about 4 chances out of 10 that Brian's cancer has
spread into (and perhaps through) the capsule or "walls" of the prostate.
- Using the appropriate table (based on Brian's PSA of 7.4 ng/ml)
to predict the probability of Brian having prostate cancer that has spread
into his seminal vesicles, we find that this probability is only 8%.
In other words, there is about 1 chance out of 10 that Brian's cancer
extends into his seminal vesicles.
- Finally, using the appropriate table (based on Brian's PSA of 7.4 ng/ml)
to predict the probability of Brain having prostate cancer which has spread into the lymph nodes,
we find that this probability is a mere 3%.
In other words, there is only a very low risk that Brian's cancer has
spread through the lymph nodes out into the rest of his body.
We can conclude that Brian has a reasonable chance that his disease is
organ confined, with his greatest risk being that the disease has spread
into the capsule of the prostate.
Permission
The original Partin coefficient tables were published in several
different places, but were initially published by Partin AW, Yoo J, Carter HB, et al. in the
Journal of Urology (1993, vol. 150, pages 110-114).
The revised Partin coefficient tables were published by Partin AW, Kattan MW,
Subong ENP, et al. in the Journal of the American Medical Association
(1997, vol. 277, pages 1445-1451).
The revised Partin tables are reproduced on The Prostate Cancer InfoLink
by permission of Dr Alan Partin, to whom we are very grateful.
[NOTE: The tables were updated in June, 2001, but this explanation still serves. The new tables are at the site of Dr. Oppenheimer's pathology lab. He is the author of "Partin Table Predictions: What Do They Really Mean?" here at InfoLink.]
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