Introduction
The initial detection of signs that you may have prostate cancer is
now most commonly the result of some regular form of check-up carried
out by your primary care physician which may include a digital rectal
examination (DRE) or a prostate specific antigen (PSA) test. The most
common symptom which may make a man go to either his primary care
physician or a urologist, and which might subsequently lead to a diagnosis
of prostate cancer, is some form of problem with normal urination.
The diagnosis of prostate cancer requires identification by a pathologist
of prostate cancer tissue in a specimen removed from the prostate
(using a technique known as a prostate biopsy). No other clinical
test can provide an absolute diagnosis of prostate cancer. Indications
for biopsy There are four basic reasons why your urologist would recommend
that you receive an initial prostate biopsy: You have an elevated
standard PSA level (of 4.0 ng/ml or more). There is a significant
change in your standard PSA level over time. You have a standard PSA
level of between 2.5 and 10.0 ng/ml and a low free/total PSA ratio
as indicated by the PSA II test. You have a suspicious-feeling prostate
on digital rectal examination. Expert urologists now recommend that
if any one of these indicators is present, you should have a biopsy
even if your ultrasound evaluation is normal.
Understanding and Using Partin Coefficient Tables
Introduction
The so-called "Partin tables" were originally developed by a group
of urologists at the Brady Institute for Urology at Johns Hopkins
University based on accumulated data from hundreds of patients who
had been treated at that institution. They are called "Partin tables"
after just one of the original contributors to this research. The
original Partin coefficient tables were revised in May 1997 based
on data from three major prostate cancer research institutions:
Johns Hopkins in Baltimore, Baylor School of Medicine in Houston,
and the Michigan Prostate Institute in Ann Arbor. In this revision,
data accumulated from 4,133 patients treated by radical prostatectomy
were used to carry out the statistical modifications. [Note: More
men have been included with a June, 2001, update. See note at top
and bottom.] The Partin coefficient tables can be used to combine
data on the PSA value, the Gleason score, and the clinical stage
of a specific patient in order to be able to try and predict the
specific risk of that patient. In using these tables, it is very
important to understand that the actual clinical value of these
tables in predicting outcome for large numbers of patients has never
actually been proved. In other words, the data which these table
offer are increasingly interesting, but cannot be absolutely used
to specify the prognosis of any particular patient with any known
degree of accuracy. Readers may be interested in comments on interpretation
of the data in the Partin tables made by Jonathon Oppenheimer, MD,
which appear elsewhere on The Prostate Cancer InfoLink Having made
this comment, Partin and his colleagues have reported that use of
the prior version of the Partin coefficient tables have resulted
in the following improvements in outcome in 1993-1996 compared to
the pre-Partin table era (1989-1993) at Johns Hopkins: Percentage
of men found to have organ-confined disease at the time of radical
prostatectomy has risen from 33% to 55% Percentage of men found
to have positive seminal vesicles or positive lymph nodes decreased
from 21% to 10%. It must be noted that at least a part of the reason
for these improvements can be associated with other factors (such
as the increased use of PSA testing and stage migration secondary
to the introduction of clinical stage T1c as a defined tumor stage).
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