PTU - Polskie Towarzystwo Urologiczne
list of articles:

Preoperative estimation of usefulness of PSA and digital rectal examination in correlation with unfavorable prognostic pathological changes occurrence in specimen after radical prostatectomy
Article published in Urologia Polska 2006/59/2.

authors

Krzysztof Bar 1, Robert Klijer 1, Radosław Starownik 1, Lech Wronecki 2, Marek Urban 1, Waldemar Białek 1
1 Katedra i Klinika Urologii i Onkologii Urologicznej Akademii Medycznej w Lublinie
2 Katedra i Zakład Patomorfologii Akademii Medycznej w Lublinie

keywords

prostate, prostate cancer, radical prostatectomy, PSA, digital rectal examination

summary

Introduction. Preoperative PSA and digital rectal examination belong to standard examination performed in patients with prostate cancer in order to estimate the degree of clinical stage.
The aim of the study. The aim of the study is estimation of usefulness of PSA and digital rectal examination with expectation of unfavorable prognostic pathological changes occurrence in specimen after radical prostatectomy.
Material and method. 96 patients operated from 2000 to 2005 were put to the test. The PSA concentration in blood and digital rectal examination in preoperative period and the occurrence of changes specified as unfavorable prognostic factors in histopathological specimen were compared.
Results. The most frequent unfavorable prognostic factor which occurred in pathomorphological examination was the low degree of cells differentiation stated in 41.6% of patients. Within the group of patients with lesions affirmed in digital rectal examination seminal vesicles infiltration occurs more frequently.
Conclusions. Significant differences in prognostic unfavourable changes were statistically stated: 1) summary Gleason ł 7 in patients with PSA concentration above 4 ng/ml, 2) positive surgical margin in patients with PSA above 8 ng/ml and 3) seminal vesicles infiltration in patients with PSA exceeding 12 ng/ml.

references

  1. Zieliński H, Łęcki A: Wartość prognostyczna PSA po radykalnej prostatektomii. Urol Pol 1999, 52, 1, 40-46.
  2. Piłatowicz A., Kozłowicz-Gudzińska I, Michalski W: Ocena wartości swoistego antygenu sterczowego (PSA) jako markera progresji stwierdzonej w scyntygrafii kośćca u chorych na zaawansowanego raka gruczołu krokowego w trakcie leczenia hormonalnego. Urol Pol 1999, 52, 2, 197-205.
  3. Stokłosa A, Malewski A, Keller E i in: Przydatność PSAD (PSA density) w rozpoznawaniu raka gruczołu krokowego niewyczuwalnego palcem (DRE) u chorych z podwyższonymi stężeniami PSA w surowicy krwi. Urol Pol 1998, 51, 1, 53-61.
  4. Kochańska-Dziurowicz A, Kasparkiewicz K, Mielniczuk M, Szewczyk W: Przydatność oznaczania surowiczego stężenia wolnej i całkowitej formy swoistego antygenu sterczowego (PSA) w zakresie stężeń PSA od 4,0 do 10,0 ng/ml w diagnostyce różnicowej łagodnego rozrostu i raka gruczołu krokowego. Urol Pol 1999, 51, 1, 67-75.
  5. O'Dowd GJ, Veltri R, Orozco et al: Update on the appropriate staging evaluation for newly diagnosed prostate cancer. J Urol 158, 1997, 687-698.
  6. Hull GW, Rabbani F, Abbas F et al: Cancer control with radical prostatectomy alone in 1000 consecutive patients. J Urol 2002, 167, 528-534.
  7. Rogers E, Gurpinar T, Dillioglugil O et al: The role of digital rectal examination, biopsy Gleason sum and prostate-specific antigen in selecting patients who require pelvic lymph node dissections for prostate cancer. Br J Urol 1996, 78, 419-424.
  8. Smith DS, Catalona WJ: Interexaminer variability of digital rectal examination in detecting prostate cancer. Urology 1995, 45, 70-75.
  9. Partin AW, Kattan MW, Subong ENP et al: Combination of prostate - specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. JAMA 1997, 14, 227, 1445-1451.
  10. Penson DF, Grossfeld GD, Li YP et al: How well does the Partin nomogram predict pathological stage after radical prostatectomy in a community based population? Results of the cancer of the prostate strategic urological research endeavor. J Urol 2002, 167, 1653-1658.
  11. Partin AW, Yoo J, Carter HB et al: The use of prostate specific antigen, clinical stage and Gleason score to predict pathological stage in men with localized prostate cancer. J Urol 1993, 150, 110-115.
  12. Pound CR, Partin AW, Eisenberger MA: Natural history of progression after PSA elevation following radical prostatectomy. JAMA 1999, 281, 1591-1595.
  13. Hruban RH, Westra WH et al: Surgical Pathology Dissection: An Illustrated Guide. 1996 Springer Verlag, New York.
  14. Olsson CA: Staging lymphadenectomy should be an antecedent to treatment in localized prostatic carcinoma. Urology 1985, 25, 4-9.
  15. Babaian RJ, Troncoso P, Bhadkamakar VA: Analysis of clicopathologic factors predicting outcome after radical prostatectomy. Cancer 2001, 91, 1414-1418.
  16. Mian BM, Troncoso P, Okihara K et al: Outcome of patients with Gleason score 8 or higher prostate cancer following radical prostatectomy alone. J Urol 2002,167, 1675-1680.
  17. Freedland SJ, Csathy GS, Dorey F, Aronson WJ: Percent prostate needle biopsy tissue with cancer is more predictive of biochemical failure or adverse pathology after radical prostatectomy than prostate specific antigen or Gleason score. J Urol 2002, 167, 516-520.
  18. Zdrojowy R, Górzyńska E: Porównanie stopnia zróżnicowania raka stercza określonego na podstawie materiału z biopsji igłowej z oceną preparatu po radykalnej prostatektomii. Urol Pol 2000, 53, 2, 170-1770.

correspondence

Krzysztof Bar
Klinika Urologii AM
ul. Jaczewskiego 8
20-954 Lublin
tel. (081) 72 44 794
kl.urol.lublin@interia.pl