Updated Nomogram to Predict Pathologic Stage of Prostate Cancer Given Prostate-Specific Antigen Level, Clinical Stage, and Biopsy Gleason Score (Partin Tables) Based on Cases from 2000 to 2005

doi:10.1016/j.urology.2007.03.042

Urology

Volume 69, Issue 6, June 2007, Pages 1095-1101

https://doi.org/10.1016/j.urology.2007.03.042 Get rights and content

Objectives

To update the 2001 “Partin tables” with a contemporary patient cohort and revised variable categorization, correcting for the effects of stage migration.

Methods

We analyzed 5730 men treated with prostatectomy (without neoadjuvant therapy) between 2000 and 2005 at the Johns Hopkins Hospital. Average age was 57 years. Multivariable logistic regression was used to estimate the probability of organ-confined disease, extraprostatic extension, seminal vesicle involvement, or lymph node involvement. Predictor variables included preoperative prostate-specific antigen (PSA) level (0 to 2.5, 2.6 to 4.0, 4.1 to 6.0, 6.1 to 10.0, and greater than 10.0 ng/mL), clinical stage (T1c, T2a, and T2b/T2c), and biopsy Gleason score (5 to 6, 3 + 4 = 7, 4 + 3 = 7, or 8 to 10). Bootstrap resampling was used to generate 95% confidence intervals for predicted probabilities.

Results

Seventy-seven percent of patients had T1c, 76% had Gleason score 5 to 6, 80% had a PSA level between 2.5 and 10.0 ng/mL, and 73% had organ-confined disease. Nomograms were developed for the predicted probability of pathologically organ-confined disease, extraprostatic extension, seminal vesicle invasion, or lymph node involvement. The risk of non-organ-confined disease increased with increases in any individual prognostic factor. The dramatic decrease in clinical stage T2c compared with the patient series used in the previous models resulted in T2b and T2c being combined as a single predictor in the nomogram.

Conclusions

These updated “Partin tables” were generated to reflect trends in presentation and pathologic stage for men diagnosed with clinically localized prostate cancer at our institution. Clinicians and patients can use these nomograms to help make important decisions regarding management of prostate cancer.

Section snippets

Patients

The institutional review board at Johns Hopkins approved this study and, when required, written informed consent was obtained from study participants. From 2000 to 2005, we identified 5988 men with clinically localized CaP who underwent RP and staging pelvic lymphadenectomy at the Johns Hopkins Hospital by any of 22 attending surgeons.

Inclusion Criteria

Men enrolled in this cohort had (a) preoperative monoclonal serum PSA level assessed on an ambulatory basis before RP, either before or at least 4 weeks after

Results

A total of 5730 men, average age (± standard deviation) 57.4 ± 6.4 years (range, 34 to 75 years), meeting the eligibility criteria were consecutively enrolled (Table 1). Of these, 89% were white and 7% African American. Prostate-specific antigen levels, GS, and clinical stage groupings are described in Table 1. The final pathologic stage demonstrated that 73%, 22%, 3%, and 1% had OC, EPE, SV+, or LN+, respectively. Comparisons with previous Partin nomograms are shown in Table 2.

Year of RP

Comment

As a result of either changed CaP biology or improved detection, men presenting with CaP today are increasingly likely to have OC.²⁰ This stage migration must be accounted for in models predicting the behavior of CaP for contemporary patients. We have used data from 5730 patients treated between 2000 and 2005 to develop an updated nomogram (Partin tables), using preoperative PSA level, clinical stage, and GS to provide the estimated probability of various final pathologic stages at RP. Because

Conclusions

We have updated the “Partin tables” on the basis of data from men treated after 2000, to reflect current trends in presentation and pathologic stage in men newly diagnosed with CaP. Clinicians can use these nomograms, based on the large cohort of men with CaP treated at our institution, to counsel individual patients and help them make important management decisions.

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Cited by (420)

Validation of user-friendly models predicting extracapsular extension in prostate cancer patients
2023, Asian Journal of Urology
There are many models to predict extracapsular extension (ECE) in patients with prostate cancer. We aimed to externally validate several models in a Japanese cohort.
We included patients treated with robotic-assisted radical prostatectomy for prostate cancer. The risk of ECE was calculated for each patient in several models (prostate side-specific and non-side-specific). Model performance was assessed by calculating the receiver operating curve and the area under the curve (AUC), calibration plots, and decision curve analyses.
We identified ECE in 117 (32.9%) of the 356 prostate lobes included. Patients with ECE had a statistically significant higher prostate-specific antigen level, percentage of positive digital rectal examination, percentage of hypoechoic nodes, percentage of magnetic resonance imaging nodes or ECE suggestion, percentage of biopsy positive cores, International Society of Urological Pathology grade group, and percentage of core involvement. Among the side-specific models, the Soeterik, Patel, Sayyid, Martini, and Steuber models presented AUC of 0.81, 0.78, 0.77, 0.75, and 0.73, respectively. Among the non-side-specific models, the memorial Sloan Kettering Cancer Center web calculator, the Roach formula, the Partin tables of 2016, 2013, and 2007 presented AUC of 0.74, 0.72, 0.64, 0.61, and 0.60, respectively. However, the 95% confidence interval for most of these models overlapped. The side-specific models presented adequate calibration. In the decision curve analyses, most models showed net benefit, but it overlapped among them.
Models predicting ECE were externally validated in Japanese men. The side-specific models predicted better than the non-side-specific models. The Soeterik and Patel models were the most accurate performing models.
Contemporary Pathological Stage Distribution After Radical Prostatectomy in North American High-Risk Prostate Cancer Patients
2022, Clinical Genitourinary Cancer
To investigate pathological stage at radical prostatectomy (RP) using the “Partin tables” approach in NCCN high-risk (HR) prostate cancer (PCa) patients.
Within the SEER 2010 to 2016 database, we identified 7,718 NCCN HR PCa patients. Cross-tabulation was used to illustrate the distribution of organ confined disease (OC, pT2), extra-prostatic extension (EPE, pT3a), seminal vesicles invasion (SVI, pT3b), lymph node invasion (LNI, pT2N1), extra-prostatic and lymph node invasion (EPE + LNI, pT3aN1), and seminal vescicale and lymph node invasion (SVI + LNI, pT3bN1), according to preoperative criteria, which consisted in PSA, clinical T stage, biopsy Gleason Score (GS). Binomial 95%CI was constructed for the reported proportions.
Median (IQR) PSA levels was 9 (6-20) ng/ml. The majority of patient harbored cT1c (51%) followed by cT2 (35%) and cT3 (14%) stage. Most patients exhibited GS 4+4 (43%). Overall, 87 vs. 15 vs. 2% of patients harbored only 1 vs. 2 vs. all 3 HR criteria. At RP, OC, EPE, SVI, and LNI rates were respectively 36%, 27%, 17%, and 19%.
Highest levels of OC were recorded for cT1c, PSA <10 ng/mL and biopsy GS4+4. Conversely, EPE, SVI and LNI were the highest in patients with cT3, PSA ≥20 ng/mL and GS 5+5. After stratification according to clinical stages, OC rates decreased with increasing PSA levels and GS. Conversely, EPE, SVI and LNI rates increased with increasing PSA and GS.
We provide a lookup table to illustrate the relationship between clinical and pathological characteristics in NCCN HR PCa patients.
Single Positive Core Prostate Cancer at Biopsy: Clinicopathological Implications and Risk Factors for Adverse Pathological Outcomes
2022, Clinical Genitourinary Cancer
Whether one positive core prostate cancer (PCa) is a low-risk disease remains to be determined. We investigated the pathological results of radical prostatectomy specimens diagnosed on single core positive prostate biopsy.
Between January 2013 and December 2019, A total of 3441 consecutive patients treated with radical prostatectomy in our institution were examined. Among them, 293 patients were diagnosed with single positive core PCa on biopsy, and the clinical parameters and pathological findings of their radical prostatectomy specimens were analyzed.
Of the 293 patients, 108 (36.9%) had undergraded Gleason Scores (GS) based on the biopsy. Positive surgical margins (PSMs), perineural invasion (PNI), extracapsular extension (ECE, pT3a) and seminal vesicle invasion (SVI, pT3b) were found in 16.4%, 15.0%, 3.4% and 2.4% of patients, respectively. In the multivariate analysis, we found that preoperative PSA level predict a significant increased risk of upgraded GS and PSMs, and biopsy GS was is a strong predictor of PNI, upgraded GS, tumor stage pT3 at radical prostatectomy.
Single positive core PCa have clinically significance in the radical prostatectomy specimens, with considerable rates of undergrading for the GS, PNI, PSMs, ECE and SVI. For patients with single positive core PCa, other prognostic factors must be considered in the treatment plan.
Seminal vesicle inter- and intra-fraction motion during radiotherapy for prostate cancer: A review
2022, Radiotherapy and Oncology
A review of studies on seminal vesicle motion was performed to improve the understanding of these treatment uncertainties. This will aid planning target volume margin reduction, which is necessary for hypofractionation of high-risk prostate cancer. Embase, Medline, Web of science Core collection, Cochrane CENTRAL register of trials and Google scholar were searched for publications including 3D information on seminal vesicle motion. In total 646 publications were found of which 22 publications were eligible for inclusion. The mean, systematic and random error of inter- and intra-fraction translations are reported, as well as rotations. The translations of the seminal vesicles is smallest in the left–right direction, whereas the rotation was largest around this axis. Although rectal and bladder filling status were the main cause for seminal vesicle motion, no apparent effect on magnitude of motion was seen when different bladder and rectal preparation protocols were used. Inter- and intra-fraction motion of the seminal vesicles is significant. In the studies, systematic and random errors range between 1–7 mm and 1–5 mm respectively, and are largely uncorrelated to prostate motion. The maximum correlation between seminal vesicle and prostate motion was reported with an R² of 0.7, while 3 other studies report lower and/or non-significant correlations. Five studies report a planning target volume margin of approximately 8 mm. This margin is in line with the results of four relevant dosimetric studies. Mitigating the inter- and intra-fraction motion of the seminal vesicles, including prostate tracking, has the potential to reduce planning target volume margins.
A class of categorization methods for credit scoring models
2022, European Journal of Operational Research
Credit scoring models are usually developed using logistic regression. For several reasons, professionals of this area frequently categorize the quantitative covariates before using them in the model. In this work, we introduce a class of methods for covariate categorization in regression models for binary response variables. Applications to real data and a Monte Carlo simulation study suggest that one of the methods of this class has a better predictive performance and a smaller computational cost than other methods available in the literature.
Standardized and Simplified Robot-assisted Superextended Pelvic Lymph Node Dissection for Prostate Cancer: The Monoblock Technique
2020, European Urology
Extended pelvic lymph node dissection (ePLND) remains the most accurate procedure for lymph node staging in intermediate- and high-risk prostate cancer (PCa) patients undergoing radical prostatectomy (RP). A superextended pelvic lymph node dissection (sePLND) can be considered in selected very-high-risk PCa patients.
To demonstrate a reproducible robot-assisted technique for sePLND at the time of RP for PCa.
From June 2016 to August 2019, 41 consecutive patients with localized PCa and very high risk for lymph node invasion (LNI) received a robot-assisted RP and a standardized 10-step monoblock ePLND, followed by a 5-step monoblock sePLND. Very high risk for LNI was defined as ≥30% risk for LNI, as calculated by the Briganti 2017 nomogram.
After performing the ePLND template resection (harvesting lymph nodes from the obturator region, external and internal iliac vessels, and common iliac vessels up to the ureter crossing), the 5-step monoblock sePLND approach was performed. The sePLND template was tailored to the common iliac vessels up to the aortic and caval bifurcation as well as the presacral region.
Lymph node yield, perioperative complications.
Overall, 41 patients received sePLND, reporting a median (interquartile range [IQR]) number of nodes removed of 23 (19–29). Median operative time (including RP, ePLND, and sePLND) was 256 min. Median preoperative prostate-specific antigen was 12 ng/mL (IQR 6.45–17.6). Disease stage pT <3 was found in 10 (24.4%) patients, pT3a in nine (22%) patients, pT3b in 21 (51.2%) patients, and pT4 in one (2.4%) patient. Of the treated patients, 54% revealed LNI: five (4.9%) in a solitary node, five (4.9%) in two to five nodes, and 12 (29.3%) in more than five nodes. Considering perioperative complications, three (7.3%) patients experienced Clavien I–II and four (9.7%) experienced Clavien ≥ III complications. Median hospital stay was 6 d. No patient underwent postoperative blood transfusion.
The 5-step sePLND approach is a reproducible and feasible technique for PCa patients at a very high risk of LNI.
In our study, we aimed to provide surgeons with a step-by-step technique for lymph node dissection, which aims to collect possibly metastatic lymph nodes of prostate cancer in an even more extended version (“superextended”) than a standard (“extended”) lymph node dissection.

View all citing articles on Scopus

: This study was supported by National Institute of Health/National Cancer Institute (NIH/NCI) SPORE grant P50CA58236, The Prostate Cancer Foundation, and Early Detection Research Network/NIH/NCI grant U01-CA86323.

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Adult urologyUpdated Nomogram to Predict Pathologic Stage of Prostate Cancer Given Prostate-Specific Antigen Level, Clinical Stage, and Biopsy Gleason Score (Partin Tables) Based on Cases from 2000 to 2005

Objectives

Methods

Results

Conclusions

Section snippets

Patients

Inclusion Criteria

Results

Comment

Conclusions

Pattern of failure after radical retropubic prostatectomy for clinically and pathologically localized adenocarcinoma of the prostate: influence of tumor deoxyribonucleic acid ploidy

J Urol

Correlation of pathologic findings with progression after radical retropubic prostatectomy

Cancer

Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer

JAMA

The use of prostate specific antigen, clinical stage and Gleason score to predict pathological stage in men with localized prostate cancer

J Urol

Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancerA multi-institutional update

JAMA

Contemporary update of prostate cancer staging nomograms (Partin tables) for the new millennium

Urology

Age and PSA predict likelihood of organ-confined disease in men presenting with PSA less than 10 ng/mL: implications for screening

Urology

A preoperative nomogram identifying decreased risk of positive pelvic lymph nodes in patients with prostate cancer

J Urol

Counseling men with prostate cancer: a nomogram for predicting the presence of small, moderately differentiated, confined tumors

J Urol

Evaluation of a nomogram used to predict the pathologic stage of clinically localized prostate carcinoma

Cancer

Predicting the presence and side of extracapsular extension: a nomogram for staging prostate cancer

J Urol

Prediction of organ-confined prostate cancer: incremental value of MR imaging and MR spectroscopic imaging to staging nomograms

Radiology

Cancer statistics, 2005

CA Cancer J Clin

An evaluation of the decreasing incidence of positive surgical margins in a large retropubic prostatectomy series

J Urol

Validation of Partin tables for predicting pathological stage of clinically localized prostate cancer

J Urol

Adult urology
Updated Nomogram to Predict Pathologic Stage of Prostate Cancer Given Prostate-Specific Antigen Level, Clinical Stage, and Biopsy Gleason Score (Partin Tables) Based on Cases from 2000 to 2005