I am having a hard time understanding the Partin Score.
My DH has a PSA of 32.5 and Gleason Score 4-5=9 aand a T2b
Could someone tell me his Partin Score results.
Partin tables (nomograms) are useful to predict the pathologic stage of a patient (status) to help in the decision on treatment choices.
In your husbandís case, the following predictive probabilities could be added to the other results provided in your post (PSA= 32.5; Gleason Score 4+5=9; Clinical stage T2b);
Baptista has reviewed the key facts from the table, so I'll just comment on the significance. The main purpose of the Partin Tables is to indicate the odds of success for prostate cancer surgery, though they are also used for a number of other purposes in case assessment. I have the 2001 version of the tables, and those earlier tables, while giving fairly similar results, give an even higher probability of 46% for penetration of the capsule, which substantially lowers the odds of success for surgery: if the cancer is already established outside the capsule, removal by surgery will not cure the cancer. On the other hand, sometimes the cancer does extend outside the capsule but is weak and not viable, and the patient can still be cured by surgery involving only the capsule and perhaps seminal vesicles.
In your husband's circumstances, based on the Partin results, radiation appears to have advantages over surgery. A key advantage is that modern radiation, while equally as good as surgery in destroying cancer that has not penetrated the capsule, can also kill cancer in those vital few millimeters beyond the capsule. Usually cancer that has spread is still close to the capsule when the case has been caught fairly early. Radiation to the pelvic bed can kill cancer at a considerably greater distance.
Accumulating studies are suggesting that radiation, at a center of excellence, is probably superior to surgery, at a center of excellence, even for low-risk cancer. Your husband's cancer, unfortunately, would be considered high-risk as more than one of the key case characteristics are on the higher risk side: PSA is more than 10; the Gleason is more than 6; and the stage is more than T2a. In contrast to that bad news, the good news is that radiation, at a center of excellence, has a fair shot at curing even high risk prostate cancer. Usually it would be combined with a course of up to two years of hormonal blockade therapy. (The latter has been my sole therapy for a high risk case. I'm now at the 12th year point and doing very well.)
There are three books that I consider vital for high risk prostate cancer patients:
"A Primer on Prostate Cancer -- The Empowered Patient's Guide," Dr. Stephen B. Strum, MD, and Donna Pogliano, 2nd ed 2005, a great orientation that mentions many best practices
"Beating Prostate Cancer -- Hormonal Therapy & Diet," Dr. Charles "Snuffy" Myers, MD (an expert and a patient himself), 2006 as I recall the year
"Invasion of the Prostate Snatchers," Ralph Blum and Mark Scholz, MD, 2010
I'm glad you like to read. That's the route to empowerment, and empowerment is key for those of us with challenging cases.
The following user gives a hug of support to IADT3since2000: ReadingALot (01-31-2011)
It strikes me that HT and brachy therapy and IMRT is a great choice for your husband.
The leading center with this approach, one that has published highly encouraging long term results, is the Dattoli Cancer Center in Sarasota, Florida. You can see Dr. Dattoli's papers by going to www.pubmed.gov and searching for (without the quotation marks) " dattoli m [au] AND prostate cancer ". I just did that and got 11 hits, including his August 2010 update of his intermediate and high-risk patients treated in the 1990s. (He has pioneered several technology improvements since then.) There is a PubMed link to a free copy of the entire paper.
He is also a leading researcher on prostatic acid phosphatase (PAP) as a predictor of outcomes for radiation therapy. You can also view his research on that in the set of 11 papers.
He and his colleagues have written a book entitled "Surviving Prostate Cancer Without Surgery -- The New Gold Standard Treatment that Can Save Your Life and Lifestyle." It provides excellent illustrations and answers many questions. The book also comments on what you should look for in choosing a doctor and facility for such treatment.
Several board participants have posted about their experiences with such an approach, including treatment by the Dattoli clinic. Most are encouraging, but one recently treated patient had trouble with side effects because other doctors did a colonoscopy or biopsy, as I recall it, which is not advisable after radiation (bwhitney).
Our insurance doesn't cover the Dattoli Center Sarasota but how did you know we lived near it?
I had no idea. What a coincidence! I mentioned him because he is one of the world's leaders in IMRT, brachytherapy, and especially an IMRT/brachy combination, and he wrote part of the best book I know of on the subject. Even if the Dattoli Center is out because of insurance, his book is still highly informative. Your post also makes me think that Dr. Dattoli knows his demographic!
There's another book from a few years ago edited by the Seattle trio of brachy experts (Blasko, Grimm and Sylvester), but it has only a chapter or two on these technologies. They're good, but short, and without photos or graphics, as I recall.