Nonpalpable stage T1c prostate cancer: prediction of insignificant disease using free/total prostate specific antigen levels and needle biopsy findings.

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.

[1]  E. Metter,et al.  Percentage of free prostate-specific antigen in sera predicts aggressiveness of prostate cancer a decade before diagnosis. , 1997, Urology.

[2]  M W Kattan,et al.  Distinguishing clinically important from unimportant prostate cancers before treatment: value of systematic biopsies. , 1996, The Journal of urology.

[3]  P. Scardino,et al.  Comparison of the pathologic features and DNA ploidy value of prostate cancers detectable by sonography and by palpation , 1993, The Prostate.

[4]  P. Humphrey,et al.  Prospective characterization of pathological features of prostatic carcinomas detected via serum prostate specific antigen based screening. , 1996, The Journal of urology.

[5]  P. Walsh,et al.  Prospective evaluation of men with stage T1C adenocarcinoma of the prostate. , 1997, Journal of Urology.

[6]  J. Oesterling,et al.  Clinical Stage B0 or T1c prostate cancer: nonpalpable disease identified by elevated serum prostate-specific antigen concentration. , 1993, Urology.

[7]  T. Stamey,et al.  Histologic differentiation, cancer volume, and pelvic lymph node metastasis in adenocarcinoma of the prostate , 1990, Cancer.

[8]  M. Koch,et al.  Tumor volume and stage in carcinoma of the prostate detected by elevations in prostate specific antigen. , 1994, The Journal of urology.

[9]  W. Fair,et al.  Prognostic significance of prostate-specific antigen in stage T1c prostate cancer treated by radical prostatectomy. , 1997, Urology.

[10]  J. Moul,et al.  Prostate‐specific antigen‐detected prostate cancer (Stage T1c): An analysis of whole‐mount prostatectomy specimens , 1997, The Prostate.

[11]  E. Bergstralh,et al.  Prostate specific antigen detected prostate cancer (clinical stage T1c): an interim analysis. , 1996, The Journal of urology.

[12]  P. Walsh,et al.  Influence of capsular penetration on progression following radical prostatectomy: a study of 196 cases with long-term followup. , 1993, The Journal of urology.

[13]  J. Fracchia,et al.  PSA‐detected prostate cancer: Contrasts with palpable disease , 1995, Journal of surgical oncology.

[14]  M M Elhilali,et al.  Reassessment of nonplanimetric transrectal ultrasound prostate volume estimates. , 1996, Urology.

[15]  L. Baert,et al.  Impalpable invisible stage T1c prostate cancer: characteristics and clinical relevance in 100 radical prostatectomy specimens--a different view. , 1997, The Journal of urology.

[16]  P. Walsh,et al.  Use of repeat sextant and transition zone biopsies for assessing extent of prostate cancer. , 1997, The Journal of urology.

[17]  D. Bostwick,et al.  PSA-detected (clinical stage T1c or B0) prostate cancer. Pathologically significant tumors. , 1993, The Urologic clinics of North America.

[18]  P. Walsh,et al.  Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. , 1994, JAMA.

[19]  J. Fracchia,et al.  The accuracy of transrectal ultrasound prostate volume estimation: Clinical correlations , 1996, Journal of clinical ultrasound : JCU.

[20]  J. Oesterling,et al.  Biopsy-proved prostate cancer in 100 consecutive men with benign digital rectal examination and elevated serum prostate-specific antigen level. Prevalence and pathologic characteristics. , 1993, Urology.

[21]  J. Oesterling,et al.  Molecular forms of serum prostate-specific antigen. The clinical value of percent free prostate-specific antigen. , 1997, The Urologic clinics of North America.

[22]  C M Tempany,et al.  Accuracy of In‐Vivo Assessment of Prostatic Volume by MRI and Transrectal Ultrasonography , 1992, Journal of computer assisted tomography.

[23]  J. Pannek,et al.  The use of percent free prostate specific antigen for staging clinically localized prostate cancer. , 1998, The Journal of urology.