Clinical use of prostate-specific antigen in the staging of patients with prostatic carcinoma.

The clinical value of serum prostate specific antigen (PSA) in the staging of prostatic carcinoma was evaluated in 62 patients who underwent radical retropubic prostatectomy. Preoperative levels of PSA (drawn in the requested conditions) were compared with the final pathological stage obtained from all surgical specimens examined for capsular penetration, seminal vesical invasion and lymph node involvement. PSA level was closely correlated with the volume and the stage of the prostatic carcinoma. 93% of the patients with PSA < or = 10 ng/ml had tumor confined to the gland. All patients with PSA > 20 ng/ml had extraprostatic tumor extension (stage C or D). Patients with histologically proved prostatic carcinoma, PSA > 20 ng/ml and negative bone scan can be assumed to have extraprostatic disease and/or lymphatic involvement. Patients with PSA < or = 10 ng/ml can be considered to have organ-confined disease, and can be spared a bone scintigraphy. Our study indicates an increasing role of PSA in the clinical staging of patients with prostatic carcinoma.