THE ROLE OF DIGITAL RECTAL EXAMINATION, BIOPSY GLEASON SUM AND PROSTATE-SPECIFIC ANTIGEN IN SELECTING PATIENTS WHO REQUIRE PELVIC LYMPH-NODE DISSECTIONS FOR PROSTATE-CANCER

Objective To examine the usefulness of clinical stage, tumour differen tiation and prostate-specific antigen (PSA) level, alone and in combin ation, to predict regional nodal metastases in individual patients wit h localized prostate cancer. Patients and methods The usefulness of di gital rectal examination (DRE), biopsy Gleason sum and PSA, alone and in combination, to predict nodal metastases in an individual patient w as examined. The study included 689 patients who had laparoscopic or o pen pelvic lymph node dissection for clinical stage T1-3 prostate canc er. The Kruskal-Wallis test, Mantel-Haenszel test, chi-squared test an d logistic regression were used for continuous, ordinal, categorical, and multivariate analysis, respectively. Results Of the 689 patients w ho underwent radical prostatectomy, 52 (8%) had nodal metastases. Alth ough clinical stage, DRE, pre-operative PSA level and biopsy Gleason s um were significantly related in the univariate analysis, only pre-ope rative PSA level and biopsy Gleason sum were significant predictors of lymph node status in a multivariate analysis. However, based on a rec eiver operating characteristic curve, a model with satisfactory sensit ivity and specificity could not be obtained. Conclusion Current estima tions of primary prostate cancer biology using pre-operative PSA level , clinical stage and biopsy Gleason sum are not sufficiently sensitive to predict nodal metastases, and pelvic lymphadenectomy remains the d efinitive method of detection.