Improved staging of prostate cancer using a new tumorscore

Introduction and Objectives: A new score was developed using the preoperati ve prostate specific antigen (PSA), the extension of cancer in the transrec tal echoguided sextant biopsies and the pathologic grade (WHO) in the biops y specimen to obtain a more accurate prediction of pathologic stage of pros tate cancer. Methods: 139 patients with prostate cancer underwent pelvic lymphadenectomy . If negative lymph nodes were diagnosed at frozen sections, radical prosta tectomy was done in the same session. 111 of 139 men underwent radical pros tatectomy. The preoperative score was developed as follows: depending on th e preoperative PSA value, between 0 and 5 points were given: 0 points for P SA 0-2,5 ng/ml, 1 point for PSA > 2,5-5 ng/ml, 2 points for >5-10 ng/ml, 3 points for >10-20 ng/ml, 4 points for >20-50 ng/ml and 5 points for PSA abo ve 50 ng/ml. The extent of tumor volume in each biopsy was measured as a pe rcentage of the total biopsy core length and the percentage of the six biop sies were added together. 0 to 5 points were given depending on percentage of added tumor volume: 0 points for 0-25% total percentage of cancer in sex biopsy cores, 1 point for >25-50%, 2 points for >50-100%, 3 points for >10 0-200%, 4 points for >200-400% and 5 points for >400%-600% total percentage . Furthermore, one point was given for high, 3 points for intermediate and 5 points for low histologic grade in the biopsy specimen. The assigned poin ts were then added together, and resulted in patients obtaining between at least one and up to 15 points. Results: 94 of 99 patients with less than a 10 point score (95%) had no lym ph node metastasis, whereas 22 of 40 men (45%) with 10 or more points had l ymph node positive prostatic carcinoma. 7 of 51 patients with less than 7 p oints (14%) had capsular penetration of the tumor and 6 patients (12%) had positive surgical margins. 52 of 60 patients (87%) with 7 or more points ha d capsular penetration of the tumor or tumorpositive surgical margins. Conc lusion: The introduction of this score to clinical use allows a more precis e prediction of pathologic tumor stage by using three preoperatively determ ined parameters united in one.