THE IMPACT OF PROSTATE-SPECIFIC ANTIGEN, ITS DENSITY AND THE GLEASON SCORE IN THE PREDICTION OF EXTRACAPSULAR DISEASE IN PROSTATE CARCINOMA

Objective: To evaluate the effectiveness of serum prostate-specific an tigen (PSA), PSA density (PSAD), the preoperative Gleason score of tra nsrectal-ultrasonography (TRUS)-guided needle biopsies and the Gleason score of the final histological examination in predicting extracapsul ar disease in prostate cancer (PCa). Material and Methods: We retrospe ctively analyzed 32 patients who underwent radical retropubic prostate ctomy as the primary treatment for their clinically localized disease. Results: Extracapsular extension was found in 21 patients. In a compa rison of different cutoff levels, the best positive predictive values were found for PSA of 20 ng/ml, PSAD of 0.2 and 0.3, a Gleason score o f TRUS-guided biopsies of 5 and one of the prostatectomy specimens of 7 with 100, 80 (both), 74 and 95%, respectively. A PSA value higher th an 20 ng/ml and a preoperative Gleason score of 7 or higher predicted extracapsular disease with specificity rates of 100 and 91%, respectiv ely. It was noteworthy that there was a statistically significant unde rgrading in the extracapsular group in the Gleason scores of TRUS-guid ed biopsies compared to the prostatectomy specimens. Conclusion: PSA l evels above 20 ngl mi and/or Gleason scores of 7 or higher in TRUS-gui ded biopsies are strong indicators of extracapsular extension of PCa.