Prediction of Pathologic Stage Based on Clinical Stage, Serum PSA, and Biopsy Gleason Score: Partin Tables in the Contemporary Era.

-To update the Partin Tables for prediction of pathological stage in the contemporary setting and examine trends in patients treated with radical prostatectomy (RP) over the past three decades.

-From January 2010 through October 2015, a total of 4459 men meeting inclusion criteria underwent RP and pelvic lymphadenectomy for histologically-confirmed prostate cancer at the Johns Hopkins Hospital. -Preoperative clinical stage, serum prostate-specific antigen (PSA) level, and biopsy Gleason score (i.e. prognostic Grade Group) were utilized in a polychotomous logistic regression model to predict the probability of pathological outcomes categorized as: organ-confined (OC), extraprostatic extension (EPE), seminal vesicle involvement (SV+), or lymph node involvement (LN+). -Preoperative characteristics and pathological findings in men treated with RP since 1983 were collected and clinical-pathological trends were described.

-Median age at surgery was 60 years (range 34-77) and median PSA was 4.9 ng/ml (0.1-125.0). -The observed probabilities of pathological outcomes were: OC disease in 74%, EPE in 20%, SV+ in 4%, and LN+ in 2%. -The probability of EPE increased substantially when biopsy Gleason score increased from 6 (Grade Group 1) to 3+4 (Grade Group 2), with smaller increases for higher grades. The probability of LN+ was substantially higher for biopsy Gleason score 9-10 (Grade Group 5) as compared to lower Gleason scores. -Area under the receiver operating characteristic curves for binary logistic models predicting EPE, SV+, and LN+ versus OC were 0.724, 0.856, and 0.918, respectively. -The proportion of men treated with biopsy Gleason score ≤6 cancer (Grade Group 1) was 47%, representing a substantial decrease from 63% in the previous cohort and 77% in 2000-2005. The proportion of men with organ-confined cancer has remained similar during that time, equaling 73% to 74% overall. -The proportions of men with SV+ (4.1% from 3.4%) and LN+ (2.3% from 1.4%) increased relative to the preceding era for the first time since the Partin tables were introduced in 1993.

-The Partin Tables remain a straightforward and accurate approach for projecting pathological outcomes based on readily available clinical data. -Acknowledging these data are derived from a tertiary care referral center, the proportion of men with OC disease has remained stable since 2000, despite a substantial decline in the proportion of men with biopsy Gleason score 6 (Grade Group 1). This is consistent with the notion that many men with Gleason score 6 (Grade Group 1) disease were overtreated in previous eras. This article is protected by copyright. All rights reserved.

BJU international. 2016 Jul 01 [Epub ahead of print]

Jeffrey J Tosoian, Meera Chappidi, Zhaoyong Feng, Elizabeth B Humphreys, Misop Han, Christian P Pavlovich, Jonathan I Epstein, Alan W Partin, Bruce J Trock

James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.