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Biopsy based algorithm for predicting likelihood of
lymph node metastases at radical prostatectomy. (January 2003)
Drs. Partin and Epstein et. al. (CANCER,
February 12, 2002, p1016) have made a potentially useful contribution to
predicting lymph node positivity by considering the number of positive
biopsies among six or more specimens. Most specialists intuitively impute
more risk as the number of biopsies increases and man y studies have
documented that association, but this nuance is not included in the
standard "Partin" tables. Their goal in the current study was to predict
which clinical presentations would have a less than 3% likelihood of nodal
positivity so that nodal sampling at RP could be avoided (and
brachytherapy patients might be better stratified). Their algorithm
applies to clinically localized disease and does not utilize PSA. It's
based on the study of 443 cases. Briefly, four or more positive biopsies
with any Gleason 4 (i.e. 3 + 4 as well as 4 + 3)) predicts a risk of 45%
for LN metastases; one or more cores positive with a dominant Gleason 4
predicted a risk of 19%; and all other patients had a risk of 2.2% for LN
positivity.
Bottom Line: Maybe Dr. Partin will supplement his prior work with this
type of data and create the "Mother of all Tables."
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