Alan Partin is a pathologist at Hopkins who developed nomograms for determining the likelihood that prostate cancer has spread to the lymph nodes using only the PSA and Gleason scores. These tables have been widely used in helping patients determine whether they should have lymph nodes sampled at the time of surgery, or for choosing different therapy. For example, a patient with a high Gleason score and high PSA might choose radiation therapy, recognizing the chances of cure with surgery aren’t that great and wanting to avoid possible surgical complications.
A new update on the Partin tables has just been published that changes some of the prognostics a bit. This is based on the very large ongoing prostate cancer data collection at Hopkins and reflects their experience in the 2006-2011 timeframe, in which more and more patients are in the category of T1c (no palpable cancer – disease found because of a high PSA). In the new nomogram which you can play with using a very simple calculator at the top of the link, you can see the effect of different stages, grades and psa on the extent of disease. For example, a man with a Gleason 3+4, PSA 4 cancer that is not palpable (T1c) has a 25% chance that disease will be found outside the prostate, but if the PSA is >10, it jumps to 42%. This might be a reason for someone with the higher PSA to consider radiation therapy more strongly, since in general, if patients have a positive surgical margin, we would recommend radiation therapy after surgery anyway.
However, you have to be careful in using these kinds of tools, just as you do with the Kattan Nomograms. None of these tools are foolproof, and I am often amazed when you start throwing different numbers in for PSA or Gleason score at how much or in some cases how little the calculations on cure or positive lymph nodes actually changes. The good news is that men seem to be doing better and better overall and the bad news is that this is driven in part by treating more and more men who might not have needed to be treated at all but are “caught” with an indolent cancer because of all of our screening. And you should already know lots about that conundrum whether or not you are reading this blog frequently.