## 4 Diagnosis of Indolent and Aggressive Forms of PCa before Treatment
### Materials and Methods  
The study included only primary patients with a confirmed diagnosis of prostate cancer and a tPSA level \(<\) 30 ng/mL according to the WHO calibration (ARCHITECT i1000 SR, Abbott, USA) before surgery. All patients were operated. The average age of patients is 62.6 \(\pm\) 0.4 years (41-85 years). Most patients with prostate cancer are persons aged 51-60 years--29.4% and 61-70 years old--53.8%; men under 50 make up 4.7%, under 70--12.2%.  
The patient's preoperative data include: the degree of differentiation of tumor tissue according to the results of biopsy (6-12 points) according to the Gleason scale; laboratory parameters: serum levels of tPSA, fPSA, \([-2]\) proPSA; classification of TNM tumor according to the results of clinical examination; age. After surgery, patients were characterized by pTNM-classification of the tumor process [26], including the assessment of tumor aggressiveness according to the Gleason scale in accordance with the pathophysiological conclusion after prostatectomy.  
Before the surgery, the patients were divided into stages T1 (12%--40 patients), T2 (69%--235 patients), T3 (19%--66 patients). After surgery, the T1-T2 stage was insufficient in 31% of cases (in 84 of 275 patients the stage was changed to pT3), T3 became excessive in 26% of cases (in 17 of 66 patients the stage was pT2). After surgery, the dominant group consisted of patients with PCa pT2 (61%), including 56.3% of patients with pT2c. In 133 (39%) patients with prostate cancer, the tumors corresponded to pT3 (pT3--19.4% and pT3b--19.6%). These data are summarized in Table 1.  
The distribution of prostate cancer patients according to the tumor grade according to the Gleason scale is presented in Table 2. Of the entire sample, according to the histological examination of biopsy material, 208 (61%) patients had highly differentiated prostate cancer (Gleason index up to 6), 109 (32%) patients had a Gleason index of 7, and 24 (7%) patients had a Gleason index 8 or more. According to the results of a pathomorphological study, the proportion of patients with a low Gleason grade of tumor malignancy (with an indicator of up to 6) decreased to 44.6%. Gleason level 7 was recorded in more patients than before surgery--in 46.6% of cases. The smallest was the group with a Gleason score of 8-9 (8.8%). Thus, after surgery, 43.8% of patients (91 out of 208) with a Gleason biopsy score of up to 6 were diagnosed with a high degree of tumor malignancy (\(\geq\)7), and 5.2% of patients (7 out of 133) had a biopsy of \(\geq\)7 showed a low tumor grade (\(\leq\)6).  
\begin{table}
\begin{tabular}{c c c c c} \hline \hline \multirow{2}{*}{**T**} & \multicolumn{2}{c}{**Before Surgery**} & \multicolumn{2}{c}{**After Surgery**} \\ \cline{2-5}  & \(n\) & \% & \(n\) & \% \\ \hline T1 & 40 & 11.7\% & — & — \\ T2, including: & 235 & 68.9\% & 208 & 61.0\% \\ T2a–b & 111 & 32.6\% & 16 & 4.7\% \\ T2c & 124 & 36.4\% & 192 & 56.3\% \\ T3, including: & 66 & 19.4\% & 133 & 39.0\% \\ T3a & 37 & 10.9\% & 66 & 19.4\% \\ T3b & 29 & 8.5\% & 67 & 19.6\% \\ \hline \hline \end{tabular}
\end{table}
Table 1: Distribution of patients by the volume of prostate tumor lesions by biopsy (T) and after surgery (pT).