Correlation between preoperative predictors and pathologic features in radical prostatectomy specimens in PSA-based screening

BACKGROUND. Measurement of percent free prostate-specific antigen (PSA), PS A density, and PSA-transition zone density (PSA-TZ density) in addition to total PSA is known to improve the specificity of PSA-based prostate cancer screening. We evaluated the ability of total PSA, percent free PSA, PSA den sity, and PSA-TZ density to predict pathologic features in radical prostate ctomy specimens. METHODS. The levels of total PSA, percent free PSA, PSA density, and PSA-TZ density assessed prior to the diagnosis of prostate cancer were correlated with the pathologic findings in 102 prostate glands with cancer obtained a t radical prostatectomy. The entire organs were examined histologically; Pe arson correlation coefficients were used for statistical analysis. RESULTS. High levels of total PSA, PSA density, and PSA-TZ density correlat ed significantly with capsular penetration, high Gleason scores, and large cancer volumes in the prostatectomy specimens. Free PSA was found to correl ate well with high Gleason scores, high percentages of cancer, and large ca ncer volumes, but not with capsular penetration. The four parameters were e valuated by means of logistic regression, which showed that only percent fr ee PSA and total PSA were significant predictors of Gleason scores greater than or equal to 7 and cancer volumes greater than or equal to 0.5 cc. With regard to clinically insignificant cancers, only percent free PSA and the Gleason score obtained at biopsy were significant predictors. CONCLUSIONS. In men whose prostate cancers are detected by PSA-based screen ing, high total PSA levels in combination with low percent free PSA levels are suggestive of a potentially more aggressive type of prostate cancer. Th is may help both patient and clinician in selecting the most appropriate th erapeutic approach. (C) 1999 Wiley-Liss, Inc.