The Impact of Prostate-Specific Antigen, Its Density and the Gleason Score in the Prediction of Extracapsular Disease in Prostate Carcinoma

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Abstract
To evaluate the effectiveness of serum prostate-specific antigen (PSA). PSA density (PSAD), the preoperative Gleason score of transrectal-ultrasonography (TRUS)-guided needle biopsies and the Gleason score of the final histological examination in predicting extracapsular disease in prostate cancer (PCa). We retrospectively analyzed 32 patients who underwent radical retropubic prostatectomy as the primary treatment for their clinically localized disease. Extracapsular extension was found in 21 patients. In a comparison of different cutoff levels, the best positive predictive values were found for PSA of 20 ng/ml, PSAD of 0.2 and 0.3, a Gleason score of TRUS-guided biopsies of 5 and one of the prostatectomy specimens of 7 with 100, 80 (both), 74 and 95%, respectively, A PSA value higher than 20 ng/ml and a preoperative Gleason score of 7 or higher predicted extracapsular disease with specificity rates of 100 and 91%, respectively. It was noteworthy that there was a statistically significant undergrading in the extracapsular group in the Gleason scores of TRUS-guided biopsies compared to the prostatectomy specimens. PSA levels above 20 ng/ ml and/or Gleason scores of 7 or higher in TRUS-guided biopsies are strong indicators of extracapsular extension of PCa.

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