Prostate Specific Antigen in Patients with Clinical Stage C Prostate Cancer: Relation to Lymph Node status and Grade

Abstract

The preoperatively drawn sera from 84 previously untreated patients who had clinical stage C prostate cancer and underwent staging pelvic lymph node dissections were sent for monoclonal Hybritech analysis to assess the usefulness of prostate specific antigen (PSA) in predicting lymph node status. Of the 84 patients 47 (56%) had positive lymph nodes at surgery. The median PSA value for all patients with nodal metastases was 11.4 ng/.ml., and for those without it was 11.2 ng./ml. Relative to Gleason score, median PSA values were 11.35 for 2-4, 12.2 for 5-7 and 10.9 ng./ml. for 8-10. Within each M.D. Anderson grade median PSA values were 10.15 for grade I, 13.2 for grade II, 12.7 for grade III and 10.5 ng./ml. for grade IV. Simultaneously drawn preoperative frozen serum samples for 28 of these patients were independently analyzed by the Yang radioimmunoassay. Comparing Hybritech and Yang methods revealed strong statistical co-association (correlation coefficient R2 = 97.36, p less than 0.00001) but neither assay was statistically associated with nodal metastasis. Although no PSA level excluded the presence of nodal disease, we suggest that a Hybritech PSA of greater than 30 ng./ml. and a Yang PSA of greater than 50 ng./ml. may serve as a weak adjunctive marker predicting nodal metastasis.

Loss of low-affinity nerve growth factor receptor during malignant transformation of the human prostate

“…We also observed an inverse correlation between the preoperative concentration of PSA and the proportion of epithelia retaining expression of the LNGFR in the prostate tissue specimens derived from the same patients. Since PSA concentration has been shown to vary widely with the histologic grade of prostate tumors, several investigators have concluded that PSA alone is inadequate for predicting the malignant potential of prostate carcinomas [8][9][10][11][12]. In this regard, in early stages of carcinogenesis represented by well-differentiated adenocarcinomas, where serum PSA levels tend to be relatively low and therefore of limited predictive value, the early loss of LNGFR expression may be a more useful indicator of malignant potential.…”

The effect of Gleason score on the predictive value of prostate‐specific antigen doubling time

“…These investigators noted that both the presence and intensity of PSA staining inversely correlated with the Gleason grade of the tumour [9]. Other studies have shown a similar correlation of PSA level with grade [28], and have noted poor expression of PSA in high‐grade cancers [7,10,29], although smaller, or exclusively serum‐based, studies have found no consistent correlation of PSA expression with grade [30].…”

Dilemma of Microscopic Lymph Node Metastases in Human Prostate Cancer

“…In stage-B disease, the frequency of metastatic deposits ranges from 20 to 30%, and in stage C, the risk increases to 35-50% [4,13], When lymph node staging is carried out, including stage-C lesions and those with seminal vesicle involvement, the risk of finding lymph node deposits increases markedly. Figures in the range of 25-30% of unexpected macro-and microscopic foci have been reported [8,13], In more carefully selected series, with low grade, low stage and low prostate-specific antigen (PSA) levels, the figures drop to 5-10% [15], In this respect, preoperative PSA measurements may be of some help; for patients with PSA levels below 10 ng/ml, métastasés are extremely rare [12,16]. It has even been proposed that performing a preoperative scintigram at these low PSA levels is unnecessary, since this examina tion will invariably be negative.…”