PREOPERATIVE SERUM PROSTATE SPECIFIC ANTIGEN LEVELS BETWEEN 2 AND 22 NG./ML. CORRELATE POORLY WITH POST-RADICAL PROSTATECTOMY CANCER MORPHOLOGY: PROSTATE SPECIFIC ANTIGEN CURE RATES APPEAR CONSTANT BETWEEN 2 AND 9 NG./ML.
- 1 January 2002
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 167 (1), 103-111
- https://doi.org/10.1016/s0022-5347(05)65392-x
Abstract
Serum prostate specific antigen (PSA) is widely used as a guide to initiate prostatic biopsies and to follow men older than 50 years old with and without prostate cancer. However, benign prostatic hyperplasia (BPH) is a common cause of serum PSA values between 2 and 10 ng./ml. A better understanding of the relationships among serum PSA, prostate cancer and BPH is important. A total of 875 men underwent radical prostatectomy at our institution between December 1984 and January 1997. Of these men 784 had a serum PSA of 2 to 22 ng./ml., including 579 with the largest cancer located in the peripheral zone of the prostate. Of the 579 men 406 had serum PSA followups for greater than 3 years after radical prostatectomy. We examined Pearson correlations (R2) between preoperative serum PSA, and the volume of Gleason grades 4/5 and 3 to 1 cancer in 784 men, separating peripheral zone from transition zone cancers. We used broken line regression with break points of 7 and 9 ng./ml. preoperative PSA to summarize the relationship of each PSA doubling to 5 different morphological variables in 579 men with peripheral zone cancer. A 9 ng./ml. break point was used for prostate weight. Trend summaries with a local regression line for the relationships between 6 morphological variables and PSA were superimposed on full scatterplots of the 579 men with PSA less than 22 ng./ml. Cox proportional hazard models were used to examine 5-year PSA failure-free probabilities based on 406 men with minimal PSA followups greater than 3 years at break points of 7 to 9 ng./ml. PSA. Pearson correlation between cancer volume and preoperative serum PSA in 875 men was weak (r2 = 0.27) and driven by large cancers with serum PSA greater than 22 ng./ml. For peripheral zone cancer the overall R2 × 100 for 641 men with low and high grade cancer was 10% and only 3% for low grade cancer, that is almost no PSA produced by these peripheral zone cancers enters the serum. All morphological variables changed at rates of doubtful medical significance below a PSA of 7 to 9 ng./ml. but at rates that were significantly worse above 9 ng./ml. R2 for these relationships was never greater than 15 %. Large individual morphological variations at all levels of PSA emphasize the serious limitation of PSA as a predictor of prostate cancer morphology. Below 9 ng./ml. prostate weight increased by 21% for each doubling of PSA but above 9 ng./ml. the increase was only 4.8%. Preoperative serum PSA has a clinically useless relationship with cancer volume and grade in radical prostatectomy specimens, and a limited relationship with PSA cure rates at preoperative serum PSA levels of 2 to 9 ng./ml. Trend summaries for prostate weight on broken line regression showed that below 9 ng./ml. BPH is a strong contender for the cause of PSA elevation, constituting the primary cause of the over diagnosis of prostate cancer.Keywords
This publication has 35 references indexed in Scilit:
- Biological Determinants of Cancer Progression in Men With Prostate CancerJAMA, 1999
- Prostate cancer detection in men with serum PSA concentrations of 2.6 to 4.0 ng/mL and benign prostate examination. Enhancement of specificity with free PSA measurementsPublished by American Medical Association (AMA) ,1997
- Prospective Longitudinal Evaluation of Men With Initial Prostate Specific Antigen Levels of 4.0 Ng./Ml. or LessJournal of Urology, 1997
- Limitations of Serum Prostate Specific Antigen in Predicting Peripheral and Transition Zone Cancer Volumes as Measured by Correlation CoefficientsJournal of Urology, 1996
- Tumor Volume and Prostate Specific Antigen: Implications for Early Detection and Defining a Window of CurabilityJournal of Urology, 1995
- Prostate Specific Antigen and Gleason Grade: An Immunohistochemical Study of Prostate CancerJournal of Urology, 1994
- Prostate Specific Antigen in the Staging of Localized Prostate Cancer: Influence of Tumor Differentiation, Tumor Volume and Benign HyperplasiaJournal of Urology, 1990
- Prostate Specific Antigen in the Preoperative and Postoperative Evaluation of Localized Prostatic Cancer Treated with Radical ProstatectomyJournal of Urology, 1988
- Prostate-Specific Antigen as a Serum Marker for Adenocarcinoma of the ProstateNew England Journal of Medicine, 1987
- Multiple Immunoperoxidase Markers in Benign Hyperplasia and Adenocarcinoma of the ProstateAmerican Journal of Clinical Pathology, 1984