PURPOSE: Approximately 25% of radical prostatectomies performed for stage T1c disease show potentially insignificant prostate cancer. We previously reported the use of serum prostate specific antigen (PSA) density and needle biopsy findings to predict potentially insignificant cancer. We now evaluate whether using free/total serum PSA levels along with needle biopsy findings can better predict tumor significance. MATERIALS AND METHODS: We studied 163 radical prostatectomy specimens of stage T1c prostate cancer in which free/total serum PSA levels were determined. Free/total serum PSA levels were measured with Tandem-MP PSA assays. Insignificant prostate cancers were organ confined with tumor volumes less than 0.5 cc and Gleason score less than 7. Advanced tumors were either Gleason score 7 or greater, established extraprostatic extension with positive margins, or positive seminal vesicles or lymph nodes. Other cases were considered as moderate tumor. Moderate and advanced tumors were considered significant. RESULTS: Of the tumors 30.7% were insignificant, 49.7% moderate and 19.6% advanced. The best model to predict preoperatively insignificant tumor was a free/total PSA of 0.15 or greater and favorable needle biopsy findings (less than 3 cores involved, none of the cores with greater than 50% tumor involvement and Gleason score less than 7). Using this model of the 18 tumors predicted to be insignificant 17 were insignificant for a positive predictive value of 94.4%. Of the 145 cases that were predicted to be significant 112 were correctly predicted for a negative predictive value of 77.2%. There was only 1 tumor predicted to be insignificant which was classified as moderate. No tumor predicted to be insignificant was advanced. CONCLUSIONS: In conjunction with needle biopsy findings, free/total PSA levels accurately predict insignificant tumor in stage T1c disease.
PURPOSE: Approximately 25% of radical prostatectomies performed for stage T1c disease show potentially insignificant prostate cancer. We previously reported the use of serum prostate specific antigen (PSA) density and needle biopsy findings to predict potentially insignificant cancer. We now evaluate whether using free/total serum PSA levels along with needle biopsy findings can better predict tumor significance. MATERIALS AND METHODS: We studied 163 radical prostatectomy specimens of stage T1c prostate cancer in which free/total serum PSA levels were determined. Free/total serum PSA levels were measured with Tandem-MP PSA assays. Insignificant prostate cancers were organ confined with tumor volumes less than 0.5 cc and Gleason score less than 7. Advanced tumors were either Gleason score 7 or greater, established extraprostatic extension with positive margins, or positive seminal vesicles or lymph nodes. Other cases were considered as moderate tumor. Moderate and advanced tumors were considered significant. RESULTS: Of the tumors 30.7% were insignificant, 49.7% moderate and 19.6% advanced. The best model to predict preoperatively insignificant tumor was a free/total PSA of 0.15 or greater and favorable needle biopsy findings (less than 3 cores involved, none of the cores with greater than 50% tumor involvement and Gleason score less than 7). Using this model of the 18 tumors predicted to be insignificant 17 were insignificant for a positive predictive value of 94.4%. Of the 145 cases that were predicted to be significant 112 were correctly predicted for a negative predictive value of 77.2%. There was only 1 tumor predicted to be insignificant which was classified as moderate. No tumor predicted to be insignificant was advanced. CONCLUSIONS: In conjunction with needle biopsy findings, free/total PSA levels accurately predict insignificant tumor in stage T1c disease.
Authors: B Helpap; G Kristiansen; M Beer; J Köllermann; U Oehler; A Pogrebniak; Ch Fellbaum Journal: Pathol Oncol Res Date: 2011-12-17 Impact factor: 3.201
Authors: Vincent Fradet; John Kurhanewicz; Janet E Cowan; Alexander Karl; Fergus V Coakley; Katsuto Shinohara; Peter R Carroll Journal: Radiology Date: 2010-05-26 Impact factor: 11.105
Authors: Stephen B Williams; Simpa Salami; Meredith M Regan; Donna P Ankerst; John T Wei; Mark A Rubin; Ian M Thompson; Martin G Sanda Journal: Cancer Date: 2011-10-17 Impact factor: 6.860
Authors: Axel Krieger; Sang-Eun Song; Nathan B Cho; Iulian Iordachita; Peter Guion; Gabor Fichtinger; Louis L Whitcomb Journal: IEEE ASME Trans Mechatron Date: 2011-10-17 Impact factor: 5.303
Authors: Joshi J Alumkal; Zhe Zhang; Elizabeth B Humphreys; Christina Bennett; Leslie A Mangold; Michael A Carducci; Alan W Partin; Elizabeth Garrett-Mayer; Angelo M DeMarzo; James G Herman Journal: Urology Date: 2008-04-02 Impact factor: 2.649