An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011

Objective To update the 2007 Partin tables in a contemporary patient population. Patients and Methods The study population consisted of 5,629 consecutive men who underwent RP and staging lymphadenectomy at the Johns Hopkins Hospital between January 1, 2006 and July 30, 2011 and met inclusion criteria. Polychotomous logistic regression analysis was used to predict the probability of each pathologic stage category: organ-confined disease (OC), extraprostatic extension (EPE), seminal vesicle involvement (SV+), or lymph node involvement (LN+) based on preoperative criteria. Preoperative variables included biopsy Gleason score (6, 3+4, 4+3, 8, and 9–10), serum PSA (0–2.5, 2.6–4.0, 4.1–6.0, 6.1–10.0, greater than 10.0 ng/mL), and clinical stage (T1c, T2c, and T2b/T2c). Bootstrap re-sampling with 1000 replications was performed to estimate 95% confidence intervals for predicted probabilities of each pathologic state. Results The median PSA was 4.9 ng/mL, 63% had Gleason 6 disease, and 78% of men had T1c disease. 73% of patients had OC disease, 23% had EPE, 3% had SV+ but not LN+, and 1% had LN+ disease. Compared to the previous Partin nomogram, there was no change in the distribution of pathologic state. The risk of LN+ disease was significantly higher for tumours with biopsy Gleason 9–10 than Gleason 8 (O.R. 3.2, 95% CI 1.3–7.6). The c-indexes for EPE vs. OC, SV+ vs. OC, and LN+ vs. OC were 0.702, 0.853, and 0.917, respectively. Men with biopsy Gleason 4+3 and Gleason 8 had similar predicted probabilities for all pathologic stages. Most men presenting with Gleason 6 disease or Gleason 3+4 disease have <2% risk of harboring LN+ disease and may have lymphadenectomy omitted at RP. Conclusions The distribution of pathologic stages did not change at our institution between 2000–2005 and 2006–2011. The updated Partin nomogram takes into account the updated Gleason scoring system and may be more accurate for contemporary patients diagnosed with prostate cancer. Keywords: prostate cancer, prostatectomy, prostage-specific antigen, nomograms, staging Introduction The ‘Partin tables’ use commonly available preoperative data – serum PSA level, clinical stage and biopsy Gleason score – to predict pathological stage at radical prostatectomy (RP). The original Partin tables used preoperative data from men who were treated between 1982 and 1991; so most were diagnosed in the pre-PSA era [1]. Updates to the Partin tables reflected the changing nature of prostate cancer diagnosis in the USA [2-6] and abroad [7-12]. With the advent of PSA screening, the incidence of prostate cancer in the USA rose dramatically over the subsequent two decades, resulting in considerable changes in the clinical and pathological stage of men diagnosed with prostate cancer [13]. Contemporary men present with lower PSA, lower clinical stage and higher likelihood of harbouring organ-confined tumours than men diagnosed with prostate cancer in the pre-PSA era [4,14,15]. Over the past 5 years, men presenting with prostate cancer are more likely to have a PSA level 10.0 ng/mL. In addition, an update to the Gleason scoring system was established at the 2005 International Society of Urological Pathology Consensus Conference [16]. The updated recommendations tend to narrow the scope of Gleason pattern 3 and widen the scope of Gleason pattern 4 [17]. Previous versions of the Partin tables were designed using a different patient population. The current work reflects the Partin nomogram in a contemporary cohort of men who underwent RP at our institution between 2006 and 2011.