Thoughts on Partin Tables

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lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 7/24/2009 12:22 PM (GMT -6)   
Was looking at another post talking about Partin Tables. When I spoke with My local urologist (Not my scheduled DaVinci Surgeon) I asked him about my numbers on the Partin Table. His reply was that the tables are out dated and have not been updated in awhile with stats so some Doctors do not use them much.
 
Just curious if anyone else has thoughts on the usefullness of the Partin Tables.
 
 Larry

Age at diagnosis 54, PSA 6.1
Biopsy 04/08 12 cores, 5 positive
Gleason 3 Cores at 4+3=7
              2 Cores at 3+4=7
Perineural Invasion Noted on biopsy

Robotic surgery Scheduled 08/12/09 at Vanderbilt, Nashville TN. 


CapnLarry
Regular Member


Date Joined Apr 2009
Total Posts : 75
   Posted 7/24/2009 1:56 PM (GMT -6)   
Johns Hopkins seems to be the caretaker for the Partin (and Han) tables. Their online version of the Partin tables urology.jhu.edu/prostate/partintables.php says in part "Now the tables have been updated with the knowledge gained from having treated thousands of patients, to reflect the trends in presentation and pathologic stage for men newly diagnosed with clinically localized prostate cancer at James Buchanan Brady Urological Institute."

and

"We have used data from 5,730 patients treated between 2000-2005 to develop an updated nomogram Partin Tables, using preoperative PSA, Clinical Stage, and GS to provide the estimated probability of various final Pathologic Stage at RP. "

FWIW.

The other Larry (we've got to stop meeting like this)
Larry Shick
Personal homepage incl. PCa story: www.sv-moira.com.
01/09: Diagnosed (age 60) biopsy PSA 4.4, free PSA 9%, T2c stage, Gleason 7 (3+4), 7 of 14 cores; 6'2", 200 lbs.
03/09: Robotic surgery (Dr. Kawachi, City of Hope) 47 gms, 10% involved, staging/Gleason unchanged (pT2cNXMX), margins clear, no ECE/sem ves involvement, fully continent from day 1, some success w/Viagra 50mg/day.
Followup: 05/09 <0.01


lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 7/24/2009 2:26 PM (GMT -6)   
That's interesting to note that they have updated the Tables! I'll have to take a look at them again.

It seems like we will keep seeing each other in cyber world! LOL

As I said in my personal email to you just bring your sailboat on up to inland waters and you can anchor in our cove and we can meet in person! Oh and if you do it has to be from April 15th to October 15th. Our water level is controlled by Tennessee Valley Authority and the cove is to low in the winter months to get your boat in.

The other Larry
Age at diagnosis 54, PSA 6.1
Biopsy 04/08 12 cores, 5 positive
Gleason 3 Cores at 4+3=7
              2 Cores at 3+4=7
Perineural Invasion Noted on biopsy

Robotic surgery Scheduled 08/12/09 at Vanderbilt, Nashville TN. 


CapnLarry
Regular Member


Date Joined Apr 2009
Total Posts : 75
   Posted 7/24/2009 2:45 PM (GMT -6)   
That's OK. In 3 weeks you'll be a grownup and you can start using the Han tables (or their competitors) just like a big boy.
Larry Shick
Personal homepage incl. PCa story: www.sv-moira.com.
01/09: Diagnosed (age 60) biopsy PSA 4.4, free PSA 9%, T2c stage, Gleason 7 (3+4), 7 of 14 cores; 6'2", 200 lbs.
03/09: Robotic surgery (Dr. Kawachi, City of Hope) 47 gms, 10% involved, staging/Gleason unchanged (pT2cNXMX), margins clear, no ECE/sem ves involvement, fully continent from day 1, some success w/Viagra 50mg/day.
Followup: 05/09 <0.01


lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 7/24/2009 2:49 PM (GMT -6)   

Yes my iniatation as a full member of this club is coming up quick.

Larry


Age at diagnosis 54, PSA 6.1
Biopsy 04/08 12 cores, 5 positive
Gleason 3 Cores at 4+3=7
              2 Cores at 3+4=7
Perineural Invasion Noted on biopsy

Robotic surgery Scheduled 08/12/09 at Vanderbilt, Nashville TN. 


Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 7/24/2009 3:35 PM (GMT -6)   
What cutoff point do they use to define a biochemical recurrence?

CapnLarry
Regular Member


Date Joined Apr 2009
Total Posts : 75
   Posted 7/24/2009 4:10 PM (GMT -6)   
The Han tables use "PSA 0.2 ng./ml. or greater" for recurrence. The Partin tables aren't concerned with recurrence, but rather with predicting (pre-surgery) whether the cancer will be organ confined, or have extra capsular, seminal vesicle involvement, or lymph node involvement, given clinical T-stage, biopsy Gleason, and PSA.
Larry Shick
Personal homepage incl. PCa story: www.sv-moira.com.
01/09: Diagnosed (age 60) biopsy PSA 4.4, free PSA 9%, T2c stage, Gleason 7 (3+4), 7 of 14 cores; 6'2", 200 lbs.
03/09: Robotic surgery (Dr. Kawachi, City of Hope) 47 gms, 10% involved, staging/Gleason unchanged (pT2cNXMX), margins clear, no ECE/sem ves involvement, fully continent from day 1, some success w/Viagra 50mg/day.
Followup: 05/09 <0.01


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 7/25/2009 8:11 AM (GMT -6)   
Although the tables are an averages thing and updated, it is still useful as a tool in predictive information. You have to remember how bizzaro PCa is, it is really non-specific from every angle:
psa tests (not reliable enough), biopsies no matter how many you get (not realiable enough), assessment on pathologies (varies hugely depending upon whom does it)...so what gleasons-percentages of cancer-perinerual invasion etc.- can be mis-interpretted, also there are atleast 18 variant types of PCa (see Bostwick Labs etc.)...so which one(s) do you have to deal with?; then there is the issue of micro-mets (see Dr. Barkens words)-whom the heck can tell you it is contained with absolute certainty?????? Then comes the decisions of multitude of treatment options to consider and basically no warranties on them.

Also, their are Narayan tables and I think Bluestein tables if someone wishes to look at other stuff and of course the nomograms for predictive outcomes for surgery etc. You might as well look at everything and get all the assessments you can get before choosing your protocol is probably decent advice.

Always get second opinions on any major treatment consideration, is a good idea.
 
Also you mentioned that your doc or such, said they don't look at Partin tables etc. (out dated etc.-?).  Surgeons don't wish to look at them as they also are selling you a treatment thus they are highly biased (also believing their method is the "only" method in many cases), there is alot of agenda and b.s. out there sold to us patients on any medical treatment these days (beware). I had 8 opinions, two from surgeons that were just days apart in their assessment, what was the verbage?
 
Doc "A" yeah curative and 1% chance of incontinence and wrote it on paper and handed it to me (talk about sales pitch). Doc "B"  Dr. Menon (DaVinci-specialist) honestly told me I will not do surgery on you  (my numbers are higher end and ridiculous), thus an honest doc gave me the heads up...why get it done for nothing but some elses profit as a motive and he did not want the money. Now alot of people might have said yes to doc "A" as he said curative and 1% chance of incontinence. Then after getting 6 more alternative opinions you can clearly see what is going on in "sales" for the treatment world side of PCa, I saw it first hand, bias, sales pitches, even lying (it was not pretty to witness).
 
PCa- aka-the jungle, twilight zone, land of bizzaro, full of mine fields  (you decide)

Post Edited (zufus) : 7/25/2009 7:34:41 AM (GMT-6)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 7/25/2009 4:16 PM (GMT -6)   
Zufus,
I hear what you are saying, but I don't believe that most doctors lie; I think they are just uninformed about PC. Surgeons know a lot about cutting, and radioligy oncologists know a lot about how to do a treatment plan, but they are not experts in the biology of PC. The 3 urologists and 2 urological oncologists I had didn't lie to me, they just didn't know how to evaluate my stats to come up with a correct treatment recommendation. They were also unaware of the many additional test available for PC. They deal with all sorts of other uninary problems and other cancers and are not experts in PC, although we all think they are.
My oncologist, on the other hand deals only in PC and has 1500 active patients and has probably treated over 10,000 PC patients. His knowledge base and skill sets in PC are far better because of his experience and training. I trust him completely, but would never have him operate on me or give me radiation; that's not his skill set.
It's not surprizing that we get different opinions from different doctors. A surgeon, radiologist and oncologist are all viewing your disease from the point of view of their own skill set and information base.
Doctor's skills also follow the normal distribution curve. On one end there are a small % of bad doctors, the vast majority are in the middle, and on the far end are the few exceptional ones. There is a huge difference in the exceptional vs the average and it takes a lot of work to find the truely exceptional ones. Doing so will significantly alter your outcome. The Partin tables reflect the average, so you can improve your odds by dealing with only the best doctors.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/25/2009 6:57 PM (GMT -6)   
JohnT, this is why I agree with you on this one, and many others would, and why we as a whole here stress to get the best, most experienced doctor you can get with your access and resources.

The good doctor's don't pretend to know what they don't know, that's why they refer. Doctors are human too and are capable of out right lying, but as a rule I would say that is rare from a professional level. And you are right, to the average urologist/surgeon, dealing with a patient with PC is just one of dozens, if not hundreds, of urinary maladies they may deal with in their practice, again, that's what specialists and referals are for.

David in SC
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, again
 
 


lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 7/26/2009 7:21 AM (GMT -6)   
I have talked to four different doctors and patients from each of three treatment areas before making my decision for the Robotic surgery.
The Doctor that stated that the Partin tables were outdated was one of the very first Doctors that I spoke to.
 
Thanks to all you have responded and to Capn Larry (the other Larry) who has been cooresponding with me off line.
 
The Larry that is waiting on his club Initiation on August 12th.
 
 
Age at diagnosis 54, PSA 6.1
Biopsy 04/08 12 cores, 5 positive
Gleason 3 Cores at 4+3=7
              2 Cores at 3+4=7
Perineural Invasion Noted on biopsy

Robotic surgery Scheduled 08/12/09 at Vanderbilt, Nashville TN. 


RJohn
New Member


Date Joined Jul 2009
Total Posts : 7
   Posted 7/26/2009 4:17 PM (GMT -6)   
Larry,
I just found this site and wanted to wade in to tell you I left my prostate in a bucket at Vandy 06/11/2009. Dr. Smith and crew are a first cabin outfit and they will take very good care of you. There is a lot to think about before your surgery but you will be in good hands and soon will be on the other side of this demon.
Cheers,
Robert

lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 7/26/2009 8:05 PM (GMT -6)   
Thanks Robert, I have heard so many good things about Dr. Smith and have talked in person to about 5 men that have had them for their robotic removal.

My wife (a nurse) was impressed with Dr. Smith when we had my consult with him and signed on the dotted line for the date with the robot.

Larry
Age at diagnosis 54, PSA 6.1
Biopsy 04/08 12 cores, 5 positive
Gleason 3 Cores at 4+3=7
              2 Cores at 3+4=7
Perineural Invasion Noted on biopsy

Robotic surgery Scheduled 08/12/09 at Vanderbilt, Nashville TN. 


sabbath lamb
New Member


Date Joined Aug 2009
Total Posts : 2
   Posted 8/3/2009 4:59 PM (GMT -6)   
Dear Larry,
 
We just got back from U of M today.  My partner's urologist and partners said that "Joe", age 68 & in good health, was not a candidate for surgery as the cancer was past the effectiveness point on the Partin Table.  He was 4+3, 3+4 and a Gleason 7, the PSA 10.3.  An initial biopsy 18 months ago was inconclusive at a PSA of 6.2.  He has a family history (his father) of prostate cancer.  The local docs said go straight to radiation. 
 
The doctor as U of M said that "Joe" was an excellent candidate for a successful surgery.  If and when issues arose later then radiation would be there as a back up option.  He stated that they do not use the Partin grading table as they felt it was outdated and stated that 2 articles will be published soon stating that.  That meeting today changed our lives.  He canceled the radiation appointment locally and will be having the surgery in 1 to 1 1/2 month when the biopsy heals.
 
Good luck.  I'll be sending good thoughts & prayers your way.      Sabbath Lamb

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/3/2009 6:51 PM (GMT -6)   
Welcome to HW Prostate Cancer group, Sabbath Lamb. Glad you found us here. Sounds like you got some good advice today, and is a good example of how conflicting treatment advice can be with PC. At 68 and in good health, with the stats you give, I couldn't imagine being told that surgery wouldn't be a good option.

Please keep us posted, and hope we can help you here.

David in SC
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, again
 
 


sabbath lamb
New Member


Date Joined Aug 2009
Total Posts : 2
   Posted 8/4/2009 6:41 AM (GMT -6)   
Thanks so much. It's such a stressful time. WIll keep you all updated.

lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 8/4/2009 7:21 AM (GMT -6)   
Sabbath Lamb,
Good luck on your husbands upcoming surgery. Mine is now 1 week away. Almost feels unreal since I've been waiting since Early May but I wanted a Dr. with lots of experience.
 
Larry
Age at diagnosis 54, PSA 5.1
Father treated for Prostate Cancer in 1997 with Proton
Biopsy 04/08 12 cores, 5 positive
Gleason 3 Cores at 4+3=7
              2 Cores at 3+4=7
Perineural Invasion Noted on biopsy

Robotic surgery Scheduled 08/12/09 at Vanderbilt, Nashville TN. 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/4/2009 8:57 AM (GMT -6)   
Larry, good luck on yours too, you are almost there. It will be so much for your head when you are on the other side. I will be thinking of you.

David in SC
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, again
 
 

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