CLINICAL USE OF PROSTATE-SPECIFIC ANTIGEN AND PROSTATE-SPECIFIC ANTIGEN DENSITY IN THE STAGING OF PATIENTS WITH CANCER OF THE PROSTATE

Objective: To examine the efficacy of prostate-specific antigen (PSA) and prostate-specific antigen density (PSAD) in staging patients under going radical prostatectomy for clinically localized prostate cancer ( CaP). Patients and Methods: Prostate gland volumes were estimated in p atients with clinically localized CaP (n=119) performing transrectal u ltrasound and employing the prolate ellipse formula. PSA was determine d using an enzyme immunoassay. All patients underwent laparoscopic pel vic lymphadenectomy followed by radical perineal prostatectomy in No d isease. The PSA density was calculated relating the Serum PSA to the s onographically estimated prostate volume. Results: The pathological ex amination of the prostatectomy specimens revealed a pT2 tumor in 52 ca ses (43.7%) and a pT3 tumor in 41 cases (34.5%). In 26 patients (21.8% ) the histological examination demonstrated metastases to the lymph no des. Patients with a pT2No CaP demonstrated a median PSA level of 8.95 ng/ml and a median PSAD of 0.3, those with a pT3No CaP demonstrated a median PSA level of 12.3 ng/ml and a median PSAD of 0.38 and those wi th a T2-3pN+ revealed a median PSA level of 22.9 ng/ml and a median PS AD of 0.7. Conclusions: Both markers, serum PSA as well as PSAD, did n ot sufficiently distinguish patients with organ-confined cancer from t hose with extracapsular tumor extension. In contrast, PSAD levels seem to provide useful additional information in the staging of patients w ith clinically localized CaP with regard to the lymph node status.