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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2005Partin tables
Hi folks, What are your thoughts on Partin tables? Ray Hello Ray. The Partin tables were the key to how I decided what if anything to do about my Gleason 6 prostate cancer. Understanding this disease requires knowledge of statistics, or at least an attitude toward them. I go with most likely outcomes. But a person who plays the lottery every week, or smokes, would approach it differently, thinking that if there's one chance in a million of me being lucky, I will. jimhoney standard RRP age 52, cured, no significant aftereffects > Hi folks, What are your thoughts on Partin tables? Ray > Hi folks, What are your thoughts on Partin tables? Ray I'm not sure just what you are asking about. It is pretty clear what the Partin tables tell you. They compared presurgical diagnoses with what the pathologist found after surgery in a large number of cases. On the basis of what they found, they determined the odds that the cancer was 1) confined to the prostate 2) extended beyond but didn't get to the seminal vesicles or lymph nodes 3) got to the seminal vesicles but not the lymph nodes 4) got to the lymph nodes The odds vary depending on Gleason score, presurgical PSA level, and stage determined by DRE. The odds given are their best estimate, but they also give a range over which the number may vary. Thus, in my case, the chance the cancer was confined to the prostate was given as 63 percent. But a range was also given of 53 to 68 percent. That means they got 63 percent from this study, but they are almost certain based on standard statistical methods that if they repeated the study with another similar population, the number they would get would be in the range 53 to 68 percent. Since the tables are based on what a pathologist sees when examining the prostate after surgery, it is always possible that some cancer which he/she can't see escaped the prostate before surgery. So even if the cancer appears to be confined to the prostate, it is still possible it may recur at a later time. Similarly, the pathologist may have found cancer in the seminal vesicles or lymph nodes, but it may never recur. It is just that recurrence is less likely in the first case and more likely in the second case. You and your doctor have to use the Partin tables to help determine whether aggressive early treatment is likely to benefit you. Unfortunately, all you get are odds, so you are making a bet in any case, but it is always better to make an informed bet than to do it blindy. Thanks James and Leonard who asked " I'm not sure just what you are asking about." I gathered the tables were a best estimate, and accept that's as good a guide as they can give. I had a PSA that went from 4.6 to 6 quite quickly and a G8 (4+4) rating. Now depending on what scale of T you put in the calculaction you get very different results, of course. In my case my own GP DRE rating was "I think it's OK, bit can't feel the otherside", the consultants assistant said " I believe there is a area on the far side that requires investigation". Thus I'm a bit lost on my T rating. CT scan shows a 2mm hot spot in my pelvis area. RT starts Feb 11 he says in hope. As an example my lowest score , assuming I read it correctly, 37% in prostate - 40% out - 15% seminal vesciles - 8% lymph. So do I read that as 37% likelihood it has stayed in my prostate - 63% likelihood it's out. Or 37% in and just take the highest 40% out. As you can read I'm a bit confused but would like to know. Ray. Well if the doctors can't feel any tumor, then it's T1c. Here are the number for Gleason 8, PSA 6, T1c: Organ Confined: 37(28-46) Extraprostatic Extension: 48(39-57) Seminal Vesicle Invasion: 13(8-19) Lymph Node Invasion: 3(1-5) So that's about 37% organ-confined, 48% extraprostatic extension (which doesn't exactly mean escaped; have you looked up an official explanation of it?), 13% chance of cancer in the seminal vesicles, and only about 3% chance it's in the lymph glands. So 63% chance it's escaped is not quite correct. You can be more optimistic than that. If you can't find a good explanation of extraprostatic extension, post again. I don't have Dr. Walsh's book with me at the moment, but we can find something. jimhoney > Thanks James and Leonard who asked " I'm not sure just what you are asking > about." I gathered the tables were a best estimate, and accept that's as [quoted text clipped - 12 lines] > but would like to know. > Ray. Thanks, Jim That was nice of you to calculate for me. I did go onto Google and check 'extraprostatic extension'. I gleaned it meant the (x)% possibility seeds from the tumour had migrated to other parts of the body other than the Seminal Vesicle and Lymph Node which are listed separately. Thus I read my results as it's unlikely to have gone to Seminal and Lymph, but circa 50 - 50 seeds have migrated to other parts of my body. Did I get that right? Please say if I got it wrong. In answer to Alan: Radio registrar said "Hot spot could be anything, however due to your relative young age (59) and aggressive cancer we are giving you the benefit of the doubt, you should think yourself lucky. And if it is cancer we can say we gave you our best shot." The tone was we don't look too close now because if it is cancer we can't offer you 'a go for it RT cure'. In answer to Steve: I agree it's a gamble, like life - there but for the grace of God go I - So you have to select views that seem the more credible to oneself and make choices. One thing cancer has taught me is you cannot predict the future, not even tomorrow. All I feel you can do is choose to go with the odds that are the best guess estimate today, but accept tomorrow it could be a completely new ball game. As like it or not the cancer club which I read most of us are in has a life membership. As an aside is there anyone out there who has a faith and has it been weakened or strengthend by being in the cancer club? Ray No, extraprostatic extension is not a term meaning migrated to other parts of the body. There's a capsule around the prostate gland, and if the cancer is found to have penetrated the capsule, that's extraprostatic extension. http://www.cancerfacts.com/GeneralContent/Prostate/gen_detection.asp?CB=14 (See the section on Pathological Stage) But even if the cancer has penetrated the capsule, it might still be localized. So for example if you had a radical prostatectomy and after removal of the prostate gland, the pathologist found extraprostatic extension, you would then have local radiation and hopefully still be all right. That happened to several people on this newsgroup. I'm not a doctor, but I believe I'm right that prostate cancer spreads to other parts of the body, usually the bones, by way of the lymphatic system. The pathological findings from which the Partin tables were composed indicate that because of your low PSA and lack of a palpable tumor, your cancer has probably not spread to other parts of your body. If I were you I would definitely believe I can beat this monster. Choose your form of treatment, and don't look back. jimhoney > Thanks, Jim > [quoted text clipped - 25 lines] > > Ray Thanks for correcting me, with the help around me from folks like yourself I'm getting there on this what the registrar called "small, but it's an aggressive little bugger", when I asked how large the tumour was. I will look at that site. I chose RT (Feb11). Yes I know it spreads via bones hence my concern on the hot spot. Thanks again Ray, best get my boxing gloves on then. > Thanks, Jim > > That was nice of you to calculate for me. I did go onto Google and check > 'extraprostatic extension'. I gleaned it meant the (x)% possibility seeds > from the tumour had migrated to other parts of the body other than the > Seminal Vesicle and Lymph Node which are listed separately. I really don't think that is what is meant in the Partin tables. Unfortunately, it is not very clear from the descriptions you usually see. The first thing to keep in mind is that the tables were constructed by comparing presurgical diagnosis to postsurgical pathology. The pathologist, examining the tissue removed from the patient, either sees cancer outside the prostate or doesn't. The pathologist has no way to know if cancer has escaped to elsewhere in the body. The second thing to notice is that the numbers add up to close to 100 percent, but never over it. In principle, any of the choices could exclude another choice. For example, there must be many cases where cancer is found in both the seminal vesicles and the lymph nodes, but it is possible it might also be found in the lymph nodes but not in the seminal vesicles. So either that happens very rarely or they just assume it is in the seminal vesicles if it is found in the lymph nodes. If that were not the case, the numbers would likely add up to more than 100 percent. It seems to me that the only sensible interpretation is that the odds are that the pathologist will find 1) cancer confined to prostate 2) cancer penetrating prostate wall but not in seminal vesicles or lymph nodes 3) cancer in seminal vesicles but not in lymph nodes 4) cancer both in seminal vesicles or lymph nodes In either cases 3 or 4, the cancer has clearly escaped the prostate. > Thus I read my > results as it's unlikely to have gone to Seminal and Lymph, but circa 50 - > 50 seeds have migrated to other parts of my body. Did I get that right? > Please say if I got it wrong. See above. All they are saying is that if you had a radical prostatectomy and a pathologist looked at the removed tissue, the odds are such and such that the pathologist would find certain things. As I said above, the pathologist can't tell if the cancer has escaped elsewhere in your body. Unfortunately, there isn't too much that can be said on the basis of the Partin tables alone about the possibility that the cancer has metastatasized. However, there are other tables or nomograms which try to predict on the basis of pretreatment diagnosis how likely the cancer is to recur. My favorite nomograms are at the Sloan Kettering website. They are based on solid research and they also tend to be optimistic. There are other calculators you can find out on the web which will predict the likelihood of recurrence which are pretty pessimistic. One thing to keep in mind is that treatment after early diagnosis has been improving recurrence rates. Some of the calculators don't take that improvement into account and so may be unduly pessimistic. Rather than getting all upset about the matter, you should talk to your doctor about it. Clearly he thinks there is a reasonable chance that radiation will do some good or he wouldn't recommend it. > In answer to Alan: Radio registrar said "Hot spot could be anything, > however due to your relative young age (59) and aggressive cancer we are [quoted text clipped - 15 lines] > > Ray On February 5, RAYMOND KING inquired: > As an aside is there anyone out there who has a faith and has it been > weakened or strengthend by being in the cancer club? Wish I did, and I've been doing a bit of exploration. Here's a cite to an article in the Journal of Clinical Oncology, found via the following links from the home page: Home>Coping>In Their Own Words>The Oncologist's Perspective. The article is entitled, "Addressing Spiritual Care: Calling for Help." The page is: http://www.jco.org/cgi/content/full/22/23/4856 Sorry, I'm unsure whether it's accessible directly; that's why I included the links. It may be necessary to register, which is quick, painless, and free. Regards, Steve J >Subject: Re: Partin tables >From: Stephen Jordan mycroftscj@earthlink.net [quoted text clipped - 5 lines] >> As an aside is there anyone out there who has a faith and has it been >> weakened or strengthend by being in the cancer club? Ah, I am a devout Christian and am absolutely secure in my faith and it has not been altered a bit by this ;-} catastrophie ;-}. An evangelist wouldn't like my doctrine at all, however... >Wish I did, and I've been doing a bit of exploration. > [quoted text clipped - 14 lines] > >Steve J > ... CT scan shows a 2mm hot spot in my pelvis area. RT starts Feb 11 he says in hope. Raymond, Do the doctors say whether they think the "hot spot" is definitely cancer? Or is it possible it's something else? I understand that a CT scan can't tell you one way or the other, it just shows some accretion on the bone that wasn't expected to be there. Will they be radiating that spot too? Alan You need to find out about that 2mm spot on the pelvis. Partin isn't going to work for you if you already have mets on the bone.  SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 Seminal Vesicle involvement, Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (4 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non Illegitimi carborundum > Thanks James and Leonard who asked " I'm not sure just what you are asking > about." I gathered the tables were a best estimate, and accept that's as [quoted text clipped - 12 lines] > but would like to know. > Ray. RT is not a cure if that 2mm hot spot is beyond the radiation field and is PC. If it IS PC, it dumps you into a different part of the Partin tables, with N or M = 1. I.P. > CT scan shows a > 2mm hot spot in my pelvis area. [quoted text clipped - 5 lines] > 37% in and just take the highest 40% out. As you can read I'm a bit confused > but would like to know. On February 5, Leonard Evens responded to Ray King's inquiry with, in pertinent part: > You and your doctor have to use the Partin tables to help determine > whether aggressive early treatment is likely to benefit you. > Unfortunately, all you get are odds, so you are making a bet in any > case, but it is always better to make an informed bet than to do it blindy. The Partin tables are shamefully underused. I told Dr. Strum that I, not my medics, had calulated my Partin (and Sloan Kettering) scores, and he responded: "In my 22 year experience seeing men with PC, and realizing that the first major nomogram was that of Partin in 1993, I have seen perhaps 1% of patients having their nomogram results done by any physician. I consider this to be in the realm of suboptimal care to negligence." One thing I like about Steve Strum is that he never leaves one in doubt as to his opinion. Regards, Steve J __ "'MD' does not mean 'Medical Deity.'" -- Stephen B. Strum, MD > On February 5, Leonard Evens responded to Ray King's inquiry with, in > pertinent part: [quoted text clipped - 13 lines] > of patients having their nomogram results done by any physician. I > consider this to be in the realm of suboptimal care to negligence." I don't doubt that Dr. Strum said that, but I find it very doubtful that urologists are generally ignoring the Partin tables when deciding on treatment. My doctor certainly paid attention to them. > One thing I like about Steve Strum is that he never leaves one in doubt > as to his opinion. [quoted text clipped - 5 lines] > "'MD' does not mean 'Medical Deity.'" > -- Stephen B. Strum, MD Quoting me quoting Dr. Strum: >> The Partin tables are shamefully underused. I told Dr. Strum that I, >> not my [quoted text clipped - 5 lines] >> 1% of patients having their nomogram results done by any physician. I >> consider this to be in the realm of suboptimal care to negligence." Leonard replied: > I don't doubt that Dr. Strum said that, but I find it very doubtful that > urologists are generally ignoring the Partin tables when deciding on > treatment. My doctor certainly paid attention to them. I don't doubt that Leonard's uro was among the 1% that Dr. Strum estimates uses the Partin tables. My uro was not. Neither was my rad onc, whom I have fired. Regards, Steve J __ "Men occasionally stumble on the truth, but most of them pick themselves up and hurry off as if nothing had happened." -- Sir Winston L. S. Churchill >> One thing I like about Steve Strum is that he never leaves one in >> doubt as to his opinion. [quoted text clipped - 5 lines] >> "'MD' does not mean 'Medical Deity.'" >> -- Stephen B. Strum, MD To all-- I agree with Steve Jordon -In attending support group meetings over the past 10 years very, very few men had the Partin Tables explained to them . Most of those who did went to the very best Centers of Excellence and were given that information and were explained the possibilities of the four categories of risk to help them decide what treatment to have. I would agree with Dr Strum's comment ( Less than 1 % ) rather than Leornard's comment that Strums comment is doubtful . Lets hear from the rest of the list --Were the Partin Tables explained to you from your URO after your Biopsy and when you were first diagnosed . TOM B +++++++++++++++++++++++++++++++++++++++++++ > Quoting me quoting Dr. Strum: > > [quoted text clipped - 36 lines] > >> "'MD' does not mean 'Medical Deity.'" > >> -- Stephen B. Strum, MD I have a very, very good uro. I think he is the best in my area. My GP thinks he is the best. He is my GP's uro. Cincinnati Magazine has listed him more than once as the best. The largest health alliance in the area named him as the head of urology. My brother works in management at the hospital and says the other docs there think he is the best. I believe that I am alive today because of him. He has been right with me and my learning about this disease, every step of the way. I've never gotten ahead of him even on late-breaking studies and news. However, I don't believe the word Partin has ever passed between his lips in our discussions. Is that an indictment? I don't think so. I think most doctors would consider themselves to be the expert and they would hire a carpenter to do carpentry. You should be able to count on a urology to know his craft. But, I have benefited from my research into this disease, at least psychologically. And, I am able to discuss it with my family.... a huge plus. And, I am able to discuss it with my uro. And, he is no longer able to lie to me to make things seem better than they are. I'm not the type of patient that needs soothing. And, in some cases, I teach my GP (recently, I gave him a blow-by-blow lesson on possible ADT SE's (thanks I.P.). "You missed your last appointment." "It's the Lupron, doc. Makes you forgetful." "You haven't lost any weight." "It's the Lupron, doc. Makes you retain weight." "Your blood pressure is up... I know... I know... it's the Lupron." Should one research? Absolutely. Is it vital to their survival? In my case, probably not. However, we have all seen on this NG where men have been led astray and research to them probably was vital, if not life-saving. We have also seen where men were led astray from persons in this NG and research again would have been vital. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 Seminal Vesicle involvement, Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (4 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non Illegitimi carborundum > To all-- I agree with Steve Jordon -In attending support group meetings over > the past 10 years very, very few men had the Partin Tables explained to them [quoted text clipped - 51 lines] > > >> "'MD' does not mean 'Medical Deity.'" > > >> -- Stephen B. Strum, MD In detail, at each stage of my assessment. I.P. "Tom Brodzeller" <lowpsa@mindspring.com> wrote > > Lets hear from the rest of the list --Were the Partin Tables explained to you > from your URO after your Biopsy and when you were first diagnosed . > To all-- I agree with Steve Jordon -In attending support group meetings over > the past 10 years very, very few men had the Partin Tables explained to them [quoted text clipped - 4 lines] > I would agree with Dr Strum's comment ( Less than 1 % ) rather than > Leornard's comment that Strums comment is doubtful . I thought the issue was not whether the doctor explained the Partin tables but whether or not he used them when making a recommendation. What my doctor did was to suggest that I read Walsh's book before meeting with him to discuss treatment. I did that, including the section on the Partin tables. I understood more than enough about what the tables said to help me discuss the options I had. I don't think the Partin tables came up explicitly in our meetings, but they were certainly implicit, and it was clear the doctor knew I had studied them. At one point I asked him about various likelihoods, and he made the very relevant point, that all the studies revealed were probabilities, and since I was one person, either these things would happen or they wouldn't. Of course, in some marginal cases, careful study of these probabilities could help with a decision, but in my case the decision was pretty clear. I was going to choose treatment aimed at attempting to cure the cancer. So worrying if the likelihood of cancer in the lymph nodes was 1 percent of 3 percent was pointless. As we have seen from the discussions here, many patients will be confused by the Partin tables and what they say. As long as the doctor explains in a general way why he is making his recommendation or if he gives the patient choices why he is doing so, detailed discussion of the Partin tables may confuse more than it helps. Of course, if the patient does ask, the doctor should respond. What I find highly unlikely is that many board certified urologists would not be aware of the Partin table probabilities when looking at a diagnosis of prostate cancer and trying to decide what to recommend to the patient. > Lets hear from the rest of the list --Were the Partin Tables explained to you > from your URO after your Biopsy and when you were first diagnosed . [quoted text clipped - 42 lines] >>>>"'MD' does not mean 'Medical Deity.'" >>>>-- Stephen B. Strum, MD First all as I asked then obviously no one explained the Partin Tables to me. In fact if had not of asked I would not have known what my Gleason score was. But this is the UK, which seems a long way behind what I guess from most of you is the USA and Canada. What isn't explained on Partin tables is the significance of the results. Ok it gives x% possibility of the cancer being confined or otherwise, but doesn't go on to say for instance, if it's penetrated the Capsular then x and x happens. A score with no meaning as it were. I wonder in general ( those not diagnosed as well as those who are) how much men are aware of the implications etc of prostate cancer compared with females on breast cancer. After all in the UK by 2005 it's expected prostate will overtake breast cancer. Ray Ray, If you don't mind my asking, since the NHS doesn't do PSA screening, how did your doctor discover your case anyway? jimhoney > First all as I asked then obviously no one explained the Partin Tables to > me. In fact if had not of asked I would not have known what my Gleason score [quoted text clipped - 13 lines] > Ray > James: Correct the NHS doesn't do PSA screening, although there are increasing calls for it to be so. In my own case I went on a medical trail, which is why I regard myself as lucky that I did. The rest followed on from there. Normally you would inform your GP you have symptoms. The state of play at the moment is some GP's take action if in doubt others do not and again there are calls for some GP's to be retrained. It's quite hit and miss if your PSA is taken. I will give an example why men don't bother. I had commented quite a few times when I went to have my Blood Pressure checked, as I'm on medication for it, that I kept going for a wee - the reply - Blood Pressure medication has that side effect, No mention of a PSA test just in case. I do wonder if they had taken that would I now have G8? I had a bit more on blood tests. The other day my GP said you may have thyroid problems so let's have a blood test. The GP's nurse on duty said I will only have one attempt, if I fail you will have to go the hospital to have it done - I went there. The result was Ok, but I need another one in 2 weeks time, but I can't get to see the nurse who just takes blood for 3 weeks. This by the way is in a big city (Birmingham). Faced with that aggro is it any wonder males don't go to their GP with symptoms? All that is ignoring what an aggro it can be to get an appointment in the first place. Ray " If you don't mind my asking, since the NHS doesn't do PSA screening, how did your doctor discover your case anyway? jimhoney Ray, Well as I keep saying, I'm not a doctor, but my assumption is that yes, it probably would have been G7 or G8 even if it were found a couple of years ago. Anyway, you should be all right after treatment, no thanks to your GP. I'm an American but I'm in the UK at the moment. This summer we will downsize to one apartment by giving up the one in Baltimore. My case was Gleason 6, so unlike you I was in a gray area in which I had to decide whether to get treatment or not. But knowing that I would be living in the UK, when I was in my 60's, although with supplementary health insurance, I did not dare put off treatment. I'm sure you saw yesterday's news about cancer care in the UK being a postcode lottery. jimhoney standard RRP age 52, cured, no significant aftereffects > James: Correct the NHS doesn't do PSA screening, although there are > increasing calls for it to be so. In my own case I went on a medical trail, [quoted text clipped - 23 lines] > > jimhoney Thanks James, Hope your visit here goes well. Thanks to you guys I must be improvimg as I smile more now. Indeed James you brought smiles "This summer we will downsize to one apartment by giving up the one in Baltimore ----But knowing that I would be living in the UK, when I was in my 60's," I thought what a small world as we downsized a few years back and Ray used to plan ahead - not know though :). Secondly turned from breakfast table, clicked and read the first line of your reply to '8 8' " You should calm down, because like Ray who just joined us, you have a dangerous case but it has probably been caught in time." I thought thanks James (dangerous case) - still smiling broadly . Ray |
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