Characterizing prostatic adenocarcinomas in men with a serum prostate specific antigen level of <4.0 ng/mL

Abstract

grading, and for the presence of PSA production. Tumours were classified as 'clinically insignificant' if the tumour volume was <0.5 mL and the Gleason score <7. RESULTSThe mean ( SD , range) preoperative PSA level was 3.04 (0.85, 0.8-3.8) ng/mL. Indications for biopsy included an abnormal digital rectal examination (61%), a PSA velocity of >0.75 ng/mL/year (12%), a strong family history of prostate cancer (3%), obstructive urinary symptoms (2%), or no obvious indication (23%). Thirty-eight (48%) tumours were clinically insignificant. Of 41 clinically significant cancers, 13 had a final Gleason score of ≥ 7, 20 had extraprostatic extension and 11 had a tumour volume of ≥ 10 mL. Of the 79 prostate cancer specimens 78 stained strongly for PSA; the exception was a Gleason 9 tumour. With a mean (range) follow-up of 3.5 (0.18-6) years only one patient had a biochemical recurrence (PSA ≥ 0.1 ng/mL). CONCLUSIONSMost prostate cancers in men with a PSA level of <4.0 ng/mL are clinically significant and PSA-producing. Many of these tumours are high-grade, high-volume and extraprostatic. We are currently exploring factors to explain why serum PSA is not elevated in these men, including tumour location, pattern of invasion and microvessel density.

Prevalence of incidental prostate cancer in patients undergoing radical cystoprostatectomy: data from China and other Asian countries

“…We attributed this mainly to the low tumor volume and low Gleason score of incidentally detected PCa because in most cases of PCa, serum PSA levels correlate well with tumor volume and Gleason score [26,27]. Similar to the results in the United States and western Europe, the diagnosed incidental PCa cases were primarily localized and well differentiated in our study [22,28].…”

Prostate‐specific antigen: A review of the validation of the most commonly used cancer biomarker

“…58 Experience with screening both in Chicago and Tyrol, Austria have reported similarly high rates of clinically significant tumors among men with a low PSA level. 59,60 Notably, in 1 series of 82 patients treated for metastatic disease, 4 patients had PSA levels Յ 2.0 ng/mL. 61 Finally, in our recent report from Southwest Oncology Group Study 8894, we noted that 153 of 1238 men with metastatic disease enrolled in this Phase III clinical trial had a PSA level Ͻ 20 ng/mL at the time of diagnosis.…”

Prostate-specific antigen in the early detection of prostate cancer

“…35 We examined 5587 men in the placebo group, all of whom eventually underwent prostate biopsy. 36 We found that, for cancer detection, the area under the receiver-operating characteristic curve (a measure of the performance of a test; the area under the receiver-operating characteristic curve of the toss of a coin has a value of 0.5, whereas that for any test with 100% sensitivity at all specificities has an area of 1.0) for PSA screening was 0.68 (95% confidence interval [CI] 0.67-0.69), a reasonable level of test performance.…”