PREOPERATIVE SERUM PROSTATE-SPECIFIC ANTIGEN AND GLEASON GRADE AS PREDICTORS OF PATHOLOGICAL STAGE IN CLINICALLY ORGAN CONFINED PROSTATE-CANCER - IMPLICATIONS FOR THE CHOICE OF PRIMARY-TREATMENT
Rd. Ennis et al., PREOPERATIVE SERUM PROSTATE-SPECIFIC ANTIGEN AND GLEASON GRADE AS PREDICTORS OF PATHOLOGICAL STAGE IN CLINICALLY ORGAN CONFINED PROSTATE-CANCER - IMPLICATIONS FOR THE CHOICE OF PRIMARY-TREATMENT, International journal of radiation oncology, biology, physics, 30(2), 1994, pp. 317-322
Citations number
45
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
Purpose: Despite careful preoperative staging, approximately 50% of pa
tients who undergo radical prostatectomy for clinical stage A2 (T1b-c)
and B (T2) prostate cancer are found to have pathologic stage C (T3-4
) or D (N1) disease. This study investigates whether preoperative seru
m prostate specific antigen (PSA) and Gleason grade predict pathologic
stage among patients with clinically organ confined prostate cancer.
Methods: The records of all 63 patients who underwent attempted pelvic
lymphadenectomy and radical prostatectomy for adenocarcinoma of the p
rostate at our institution in 1990-91 were retrospectively reviewed. R
esults: Patients with a preoperative serum PSA of 12.5 ng/mL or greate
r had an 81% incidence of pathologic upstaging to stage C (T3-4) or D
(N1) compared with 38% for patients with a PSA less than 12.5 (p = 0.0
015). The incidence of various pathologic findings for prostate specif
ic antigen greater than or equal to 12.5 vs, prostate specific antigen
< 12.5 was as follows: seminal vesicle involvement 29% vs. 5% (p = 0.
0186), lymph node metastases 24% vs. 0% (p = 0.0029), capsular penetra
tion 71% vs. 38% (p = 0.0424), and positive margins 47% vs. 36% (p = 0
.56). None (0/3) of the patients with Gleason grade 4 or less were pat
hologically upstaged compared with 49% (24/49) of patients with grade
5-7 tumors (p = 0.15) and 82% (9/11) of patients with grade 8 or highe
r cancers (p = 0.0474, grade 5-7 vs. 8-10). Within the group of patien
ts with Gleason grade 5-7, a prostate specific antigen of 12.5 ng/mL o
r greater predicted an 79% rate of upstaging compared with 37% for pat
ients with prostate specific antigen less than 12.5 (p = 0.0098). Conc
lusion: Patients with clinical Stage A2 (T1b-c) or B (T2) prostate can
cer who have Gleason grade 8-10 tumors and those patients with Gleason
grade 5-7 tumors with a preoperative serum prostate specific antigen
of 12.5 ng/mL or higher have a high incidence of pathologic upstaging.
These patients should be preferentially treated with external beam ra
diation in most cases.