Clinical and Pathologic Features of Prostate Cancer with Prostatic-Specific Antigen (PSA) Less Than 2.5 ng/ml. A Study of 209 Cases.
Leonardo Roquero, Oleksandr Kryvenko, Shyam Sukumar, Mireya Diaz, Mani Menon, Nilesh Gupta. Henry Ford Hospital, Detroit, MI
Background: A PSA level of 4.0 ng/mL or greater is the recommended threshold for further evaluation or biopsy; however, recent screenings have suggested the use of a set point of a PSA level > 2.5 ng/mL to trigger a prostate biopsy. Men who undergo biopsy with a PSA level of less than 2.5 ng/mL have other significant prostate cancer risk factors, including suspicious findings on digital rectal examination (DRE), a strong family history, or an increasing PSA velocity.
Design: Pathology files of our hospital were searched for patients who had undergone radical prostatectomy (RP) with initial PSA of less than 2.5 ng/mL between the periods of 2001 to 2008. All cases with prior hormonal therapy were excluded. Clinical parameters recorded were age, race, initial PSA at diagnosis, clinical presentation, family history of prostate cancer and biochemical recurrence (BCR). Pathologic parameters noted were Gleason score (Gl), prostate weight, tumor volume, presence or absence of extraprostatic extension (EPE), seminal vesicle invasion (SVI) and lymph node metastasis (MET).
Results: 209 patients were identified with a mean age of 59 years (38-74) and mean PSA of 1.7 ng/mL (0.18-2.49), 102 (48.8%) presented with an abnormal DRE and 57 (27.2%) had strong family history of prostatic carcinoma. Increasing PSA velocity was only seen in 9 (4.3%) of patients. Race was known in 115 patients, 97 were Caucasians, 15 African American and 3 Asians. Clinical T stage was available in 175 cases, 91 (52%) were cT1 and 84 (48%) were cT2.
Following RP with a mean prostatic weight of 39 grams (16.44-86.16), 121 (59%) showed Gl 6, 70 (33%) showed Gl 7 and 18 (8%) were Gl 8 and above. EPE was observed in 30 (14%), SVI in 4 (2%) and MET in 2 (1%). BCR was seen in 4% of patients (8/182) with a average follow up of 23 months and all were pathologic stage T3.
Out of 46 patients with PSA < 1.0 ng/mL, 43 (93.5%) were Gl 6 and 3 (6.5%) were Gl 7; EPE was seen in 3 (6.5%) and SVI in 1 (2.1%). 36 patients recieved lymph node dissection, none showed MET.
Conclusions: In spite of adverse clinical parameters of abnormal DRE and strong family history, our data show that majority of prostate cancer in PSA < 2.5 ng/mL are organ confined and low grade. BCR was only seen in patients with higher Gleason's score (Gl 8 and above) with non organ confined disease. We did not find adverse pathologic outcome in patients with very low PSA values (<1.0 ng/mL).
Category: Genitourinary (including renal tumors)
Tuesday, March 1, 2011 11:30 AM
Platform Session: Section A, Tuesday Morning