The Value of Prostate Specific Antigen, Digital Rectal Examination, Transrectal Ultrasound, and Transrectal Ultrasound-Guided Biopsy in Prediction of Final Pathologic Diagnosis in Prostate Cancer

Paick, Seong Hyun; Jung, Byong Chang; Park, Dal Woo; Kim, Jeong Hyun; Jeong, Seong Jin; Byun, Seok Soo; Kwak, Cheol; Lee, Sang Eun

Abstract

PURPOSE: We evaluated the clinical utility of preoperative serum prostate specific antigen (PSA), digital rectal examination (DRE), transrectal ultrasound (TRUS), and findings of TRUS-guided biopsies in predicting the final pathologic diagnosis in patients who underwent radical prostatectomy.
MATERIALS AND METHODS
The medical records of 53 patients with prostate cancer who underwent radical prostatectomy from september 1995 to June 2000 were reviewed. Pathologic variables evaluated on sextant biopsies included total length and percent of cancer on one core, number of cores involved and Gleason score. Clinical variables included PSA and PSA density (PSAD). Also subjects were divided into two groups; organ-confined group versus non organ-confined group.
RESULTS
On final pathologic examination, 38 patients (72%) had organ-confined, 11 patients (21%) had margin positive, 6 patients (11%) had capsular penetration and 6 patients (11%) had seminal vesicle involvement. None had pelvic lymph node metastases. Chi-square analysis demonstrated significant correlations between PSA, PSAD, number of cores involved, total length of cancer on one core and organ-confined prostate cancer. When PSA level was 11 or more, PSAD was 0.34 or more, biopsies had Gleason scores of 7 or more, number of cores involved was two or more, and total length of cancer on one core was 0.4cm or more, possibility of cancer being non organ-confined increased
CONCLUSIONS
This study demonstrates that PSA, PSAD, Gleason score in sextant biopsy, number of cores involved, total length of cancer on one core are clinically useful predictors of organ-confined disease. This may help both patients and clinician in selecting the most appropriate therapeutic approach.