THE ROLE OF TRANSRECTAL ULTRASOUND-GUIDED BIOPSY-BASED STAGING, PREOPERATIVE SERUM PROSTATE-SPECIFIC ANTIGEN, AND BIOPSY GLEASON SCORE IN PREDICTION OF FINAL PATHOLOGICAL DIAGNOSIS IN PROSTATE-CANCER

Objectives. To evaluate the role of ultrasound-guided systematic and l esion-directed biopsies, biopsy Gleason score, and preoperative serum prostate-Specific antigen (PSA) as three objective and reproducible va riables to provide a reliable combination in preoperative identificati on of risk of extraprostatic extension in patients with clinically loc alized prostate cancer. Methods. The case records of 813 patients who underwent radical prostatectomy for clinically localized prostate canc er were analyzed. All had multiple systematic biopsies, two to three f rom each lobe, in addition to lesion-directed biopsies. Additionally, biopsies were done on seminal vesicles (SVs), if abnormal. Based on bi opsy results, patients were classified as having Stage B1 (T2a-T2b) or B2 (T2c) disease, depending on whether biopsies from one or both lobe s were positive and Stage C (T3) if there was evidence of SV involveme nt by biopsy or biopsies from areas of extracapsular extension as seen on transrectal ultrasound (TRUS) were positive. Logistic regression a nalyses with log likelihood chi-square test was used to define the cor relation between individual as well as combination of preoperative var iables and pathologic stage. Results. On final pathologic examination, 473 (58%) patients had organ-confined disease, 188 (23%) had extracap sular extension (ECE), with or without positive surgical margins, and 72 (9%) had SV involvement. Eighty (10%) patients had pelvic lymph nod e metastases. Biopsy-based staging was superior to clinical staging in predicting final pathologic diagnosis. Logistic regression analyses r evealed that the combination of biopsy-based stage, preoperative serum PSA, and biopsy Gleason score provided the best prediction of final p athologic stage. Probability plots constructed with these data can pro vide significant information on risk of extraprostatic extension in in dividual patients. Conclusions. This study demonstrates that TRUS-guid ed systematic biopsy in combination with preoperative serum PSA and bi opsy Gleason score may provide a cost-effective approach for managemen t decisions and prognostication in patients with prostate cancer.