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Medical Forum / Diseases and Disorders / Prostate Cancer / December 2007Understanding the Partin Tables
I am beginning to understand the Partin Tables but have some questions: My "numbers" for purposes of the Partin Tables are: PSA-3.14 Gleason-6 Clinical Stage-T1c Based upon my numbers, the Partin tables show: Organ confined -88 (86-90) Extraprostatic extension-11 (10-13) Seminal vesicle- 1 (0-1) Lymph node -0 (0-0) As I understand it, that means that the probabliity that the cancer is "organ confined" is %88, "extraprostatic" %11 and so forth. Obviously the further the cancer has spread from the prostate itself, the more "serious" the cancer probably is. So in trying to understand these numbers, if we have prostate cancer our wish would be that it be "organ confined" because we all know that very many men die of other causes while having "organ confined" prostate cancer. In my case it appears that as long as all my numbers (PSA,Gleason, Clinical Stage) remain the same then we can say that the odds that my cancer is "organ confined" is about 90%-9 out of 10. Would appreciate any feedback regarding my analysis of how I understand the Partin tables. Thanks, Sy > I am beginning to understand the Partin Tables but have some questions: > [quoted text clipped - 29 lines] > > Sy That's exactly how I understand the meaning of the tables, having read Patrick Walsh's book (Walsh co-developed the tables). Note that based on the 2001 tables the organ confined/extraprostatic ratio would be 84/15 rather than 88/11. I assume you have used more recent statistics. That BTW is the caveat that Walsh adds: the tables are just statistics; your chances may vary. Hello Sy, Organ confined prostate cancer is cancer that has not spread. Like a forest fire, if we can catch the start of the blaze, and "confine" that, we have saved the forest. And like a forest fire if a spark gets out, and wind catches it, we have more trouble and or metastisis...spread. No man really wishes for either.....confined or not. Not being a Dr. but knowing the rudiments of this ordeal, the Partin Tables give clues as to the type and spread of cancer. the slides the Dr.s have can give them a clue to the aggressive nature of the type of cancer. Having organ confined cancer does not guarantee that we will die of another ailment and not prostate cancer. That is why we have these tests to determine the type and spread of cancer so that like the forest fire, it can be treated before it causes further harm. Sorry for the simplistic way of stating this ordeal, and you do have good numbers for aggressive treatment at this stage. Wish you the best... jloomis prostate cancer @ 49 (1999) RP Nov 1999. Still kicking........ > I am beginning to understand the Partin Tables but have some questions: > [quoted text clipped - 29 lines] > > Sy Hi, I was with you until the sentence that read "you do have good numbers for aggressive treatment at this stage". It's interesting how people see the same numbers differently. My personal interpretation of my numbers is that "I have good numbers for my current choice which is "active surveillance". Thanks, Sy > Hello Sy, > Organ confined prostate cancer is cancer that has not spread. Like a [quoted text clipped - 48 lines] > > > > Sy Active surveillance is waiting until active action. This would be like a fireman, standing back with the hose, and waiting to see which way the fire goes. You can do this, and wait. There is not problem to this kind of method. On the other hand, many firefighters would choose to put out the fire before its inevitable spread. Your decision. jloomis > Hi, > [quoted text clipped - 66 lines] >> > >> > Sy > Active surveillance is waiting until active action. This would be like a > fireman, standing back with the hose, and waiting to see which way the fire > goes. You can do this, and wait. There is not problem to this kind of > method. On the other hand, many firefighters would choose to put out the > fire before its inevitable spread. Many firefighters choose to light a few candles these days and leave it on, as long as the fire doesn't spread; spreading is not "inevitable". AS is not "waiting until active action". It is "waiting to see if action is required". Should one wait for capsular penetration? There is not much sense in that. jloomis >> Active surveillance is waiting until active action. This would be like a >> fireman, standing back with the hose, and waiting to see which way the [quoted text clipped - 6 lines] > is not "waiting until active action". It is "waiting to see if action is > required". > Hi, > [quoted text clipped - 61 lines] >>> >>> Sy Let me say again. You can't draw such a conclusion on the basis of the Partin Tables. You would have to have a reliably researched model which would give you the likelihood of metastasis some time in the future if you didn't get treatment now and relied on active surveillance instead. the partin tables only tell you the probabilities about what the pathologist will find if you ahve a radical prostatectomy. >It's interesting how people see the same numbers differently. My >personal interpretation of my numbers is that "I have good numbers for >my current choice which is "active surveillance". No surprise that interpretations differ when we're lost in such inexact data, hopelessy inadequate science, irrational optimism/pessimism and the tantalising 'cure'/SE seesaw. You say you have good numbers for active surveillance. Partin reports on a snapshot. What about your doubling time? Since you first posted here, enough time will have elapsed to enable you to test your 22month PSA-DT, and of course as an *active* surveillant you'll have had a new reading. How's that going? Roast Beef, I will be getting my PSA tested in early January. Will let you know the results. Thanks for asking. Sy > >It's interesting how people see the same numbers differently. My > >personal interpretation of my numbers is that "I have good numbers for [quoted text clipped - 9 lines] > PSA-DT, and of course as an *active* surveillant you'll have had a new > reading. How's that going? Hi Sy, In your post you stated,"Obviously the further the cancer has spread from the prostate itself, the more "serious" the cancer probably is. Maybe someone will correct me if I'm wrong but I believe most would consider any penetration of the prostate capsule serious. I also believe that if in fact the cancer does penetrate the capsule then by its nature it is already aggressive. The Partin Tables were not developed with watchful waiting or active surveillance in mind therefore they aren't applicable in such cases. If one is considering WW/AS then one needs to consider the appropriate criteria and if they in fact meet that criteria. One shouldn't make the mistake of choosing a Box and then trying make everything fit into it by reading more into it than is there. This is just one of many articles on the subject but it is consistent with all others that I have read. http://urology.jhu.edu/prostate/advice1.php Urology at Hopkins: Brady Urological Institute Ron S. -- Message posted using http://www.talkaboutsupport.com/group/alt.support.cancer.prostate/ More information at http://www.talkaboutsupport.com/faq.html > The Partin Tables were not developed with watchful waiting or active > surveillance in mind therefore they aren't applicable in such cases. The Partin Tables are about the probability of cancers having spread. What treatment, if any, you choose is entirely irrelevant. Rhonda, You haven't a clue as to the purpose of the Partin Tables. You are like a few others that have come an gone that take what you want out of context and interpret it to your own liking. You do many that come here a disservice by doing so and just add more confusion to the amount of data that we all try to make sense of with this cancer. Your apparent ability to comprehend the written word is lacking. If you trolled somewhere else you might find a home. Ron S. -- Message posted using http://www.talkaboutsupport.com/group/alt.support.cancer.prostate/ More information at http://www.talkaboutsupport.com/faq.html >> The Partin Tables were not developed with watchful waiting or active >> surveillance in mind therefore they aren't applicable in such cases. > > The Partin Tables are about the probability of cancers having spread. > What treatment, if any, you choose is entirely irrelevant. No, No, No! The Partin tables tell you something about what a pathologist will find after surgery by examining the sample he gets. That may give some rough indication of how likely the cancer is to metastatize at some point in the future, but there are studies which are based on following men for many years after different treatment protocols (or after no treatment). That is the data you have to look at. >>> The Partin Tables were not developed with watchful waiting or active >>> surveillance in mind therefore they aren't applicable in such cases. [quoted text clipped - 8 lines] > based on following men for many years after different treatment > protocols (or after no treatment). That is the data you have to look at. Yes, yes, yes. Here's what co-developer Walsh himself writes about "how to use the tables": "[plugging in data] ... there is almost a 98% probability that the cancer will be confined to the surgical specimen - what would be removed in a RP, if the man chooses this avenue of treatment - and a very low probability that the cancer has escaped to the seminal vesicles or lymph nodes..." Thus, as I said, the Partin Tables are about the probability of cancers having spread, i.e. spread beyond the prostate itself. Those probabilities apply regardless of what the patient decides to do next (rp, radiation, nothing, praying, buy a new car). Thus, ronju's statement is erroneous. If the patient in fact elects rp the Han tables may be used to predict the probability of recurrence (i.e. detectable PSA level). Hi Sy, In your post you stated,"Obviously the further the cancer has spread from the prostate itself, the more "serious" the cancer probably is. Maybe someone will correct me if I'm wrong but I believe most would consider any penetration of the prostate capsule serious. I also believe that if in fact the cancer does penetrate the capsule then by its nature it is already aggressive. The Partin Tables were not developed with watchful waiting or active surveillance in mind therefore they aren't applicable in such cases. If one is considering WW/AS then one needs to consider the appropriate criteria and if they in fact meet that criteria. One shouldn't make the mistake of choosing a Box and then trying make everything fit into it by reading more into it than is there. This is just one of many articles on the subject but it is consistent with all others that I have read. http://urology.jhu.edu/prostate/advice1.php Urology at Hopkins: Brady Urological Institute Ron S. -- Message posted using http://www.talkaboutsupport.com/group/alt.support.cancer.prostate/ More information at http://www.talkaboutsupport.com/faq.html > I am beginning to understand the Partin Tables but have some questions: > [quoted text clipped - 29 lines] > > Sy You have to understand how the Partin tables wer constructed. They took a large number of men whose diagnoses before surgery was known. They then analyzed their post surgical pathology reports. So for men whose cancer was diagnosed as T1c and had a PSA before surgery in a certain range (indicated in the tables) that contained yours (3.4) and for whom the Gleason score was 6=3+3, the percentage of cases in which the cancer was found to be organ confined was 88 percent, the percentage in which there was extraprostatic extension, but no cancer in the seminal vesicales was 11 percent, the percentage in which there was cancer in the seminal vesicles was 1 percent, and there were no cases observed with cancer in the lymph nodes. But what you have to keep in mind that the pathologist when examining your prostate after surgery can only report what he sees. For example, some cancer could have escaped the prostate, be somewhere in the sample and missed by the pathologist or some cancer might have escaped outside the sample examined by the pathologist. Some, but not all of these cancers will recur. In addition, not all cancers which the apthologist finds have escaped the prostate will recur after treatment. So the Partin tables, while helpful, can't be used to determine the risk of metastasis at a later date. The only way to do that is to follow a large number of men for years and see how often the cancer recurs. Note that in such cases, the cancer didn't pop up out of nowhere. It had almost certainly already escaped the prostate at the time of surgery although not found by the pathologist. Various researchers have done that work and constructed models from which they can, with some degree of confidence, predict the likelihood of recurrence within specified time periods. One place you can find a reliable calculator of this sort is at the Sloan Kettering website. It will give you the likelihood of recurrence based on pre-surgical diagnosis and also the risk based on the results following surgery. In a case like yours, I think you will find that the likelihood of non-recurrence within ten years is something like 97 percent. Rhonda Joy, If what you say is true that the Partin Tables were created to give the probability of the cancer escaping the prostate, my question to you is why would anyone care if it had escaped? Ron S. -- Message posted using http://www.talkaboutsupport.com/group/alt.support.cancer.prostate/ More information at http://www.talkaboutsupport.com/faq.html I had a feeling Rhonda wouldn't answer my question. You see according to it, two bored individuals had nothing better to do one evening so they decided to examine prostates that had been removed from patients and make a nomogram to predict the probability of ones cancer escaping the prostate just for the fun of it. I guess surgery schedules must have been slow at that time. Ron S. -- Message posted using http://www.talkaboutsupport.com/group/alt.support.cancer.prostate/ More information at http://www.talkaboutsupport.com/faq.html Leonard, Thanks for the clarification. So if I understand correctly, given my numbers and assuming I were to get a RP , my chance of recurrence would be about 3%. Is that correct? Also, when one says "recurrence" where is the locus? I guess it could be prostate,lymph or bone or all? Sy > > I am beginning to understand the Partin Tables but have some questions: > > [quoted text clipped - 65 lines] > In a case like yours, I think you will find that the likelihood of > non-recurrence within ten years is something like 97 percent. > Leonard, > > Thanks for the clarification. > > So if I understand correctly, given my numbers and assuming I were to > get a RP , my chance of recurrence would be about 3%. Is that correct? You should really go to the Sloan Kettering website and try it yourself. When I tried it I had to make some assumptions about your diagnosis such as the number of cores which were positive. When you enter all the data, you may find it comes up with a slightly different estimate. But it won't be very different. Also, note that this is the likelihood of recurrence within ten years, not over your entire lifetime. Although it is not too likely, prostate cancer can recur after 15 or more years. Don't worry too much about the exact figures. In a case like yours, if the cancer is treated by an appropriate method, the chances of recurrence are low enough that it doesn't make a lot of sense to spend your time worrying about it. Most likely, you will die of something else. let me emphasize again that all these studies are predictions about what may happen following treatment. You can't draw conclusions from these studies about what might happen if you defer treatment. A certain number of Gleason 6 cases, with relatively low PSA, may in fact be candidates for expectant management, but the studies and statistics supporting that are different from Partin's work and the work of those who developed the Sloan Kettering calculator. > Also, when one says "recurrence" where is the locus? I guess it could > be prostate,lymph or bone or all? You can find good discussions of this in either Walsh or Scardino. But what they are talking about is rising PSA or less often the appearance of symptoms. Rising PSA is called biochemical recurrence because it precedes often by many years the appearance of symptoms of metastasis. Biochemical recurrence may indicate cancer developing locally in the prostate bed, in which case it is possible, following surgery, to treat it by radiation. Or it could be because of cancer developing at distant sites, in which case hormone therapy would be the appropriate therapy. But often that can be delayed for many years. > Sy > [quoted text clipped - 66 lines] >> In a case like yours, I think you will find that the likelihood of >> non-recurrence within ten years is something like 97 percent. Leonard, Thanks for the clarification. So if I understand correctly, given my numbers and assuming I were to get a RP , my chance of recurrence would be about 3%. Is that correct? Also, when one says "recurrence" where is the locus? I guess it could be prostate,lymph or bone or all? Sy > > I am beginning to understand the Partin Tables but have some questions: > > [quoted text clipped - 65 lines] > In a case like yours, I think you will find that the likelihood of > non-recurrence within ten years is something like 97 percent. > Leonard, > > Thanks for the clarification. > > So if I understand correctly, given my numbers and assuming I were to > get a RP , my chance of recurrence would be about 3%. Is that correct? > Sy No Sy, for that determination you need the data obtained at the time of the RP (the Gleason score may very well differ) and use the Han tables, that were developed for that purpose. > No Sy, for that determination you need the data obtained at the time of > the RP (the Gleason score may very well differ) and use the Han tables, > that were developed for that purpose. Safire...If by the "Han tables" you are referring to the paper by M. Han, A. W. Partin, M. Zahurak, S. Piantadosi, J. Epstein and P. C. Walsh; J. Urol., 169, 517-523, 2003 (the paper can be found at http://www.prostate-help.org/download/jhnomo.pdf this paper is often referred to as the "Hopkins nomograms"), then Tables 2-4 do allow post-RP biochemical recurrence-free predictions based on pre-operative characteristics (TNM staging, pre-op PSA, biopsy GS); Tables 5-6 allow similar predictions based on post- operative characteristics (organ confinement status, pre-op PSA, pathological GS). Based on Sy's pre-op PSA, TNM staging and biopsy GS, and using Table 2 in the nomogram, Sy's expected biochemical recurrence-free probability at 10 years post-RP would be 97% (range: 91-99%); conversely, as Sy states it, his probability of biochemical recurrence would be "about 3%."...Best wishes and good health, ron Rhonda Joy, You need to do a better job reading if you are going to make comments on this subject. Ron S. -- Message posted using http://www.talkaboutsupport.com/group/alt.support.cancer.prostate/ More information at http://www.talkaboutsupport.com/faq.html > I am beginning to understand the Partin Tables but have some questions: > [quoted text clipped - 29 lines] > > Sy Dear Sy, Don't have time to read the entire thread. However, you should pull up my post here, "5 out of 6 Men May Not Need Treatment". It discusses Gleason "grade inflation," which you need to factor in when looking at the Partin Tables. In this case, the the trend is your friend: 1) A subset of people, mostly those currently diagnosed with G6 or (to a lesser extent) G7-grade tumors, will have a more optimistic long- term prognosis when using older nomograms, such as the Partin Tables Good luck, Leah Hi Leah, With all do respect, the Partin tables have been revised as of 2005. Also Sy's prognosis has been trumped by his tumor size. All studies limit tumor size to small volume tumors. John Hopkins states the tumor must be under 50% by volume and no more than two positive cores in the samples taken. Sy has three cores of six with 40%,60%, 80% if I remember right. Ron S. -- Message posted using http://www.talkaboutsupport.com/group/alt.support.cancer.prostate/ More information at http://www.talkaboutsupport.com/faq.html |
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