1096 THE ABILITY OF PSA DENSITY TO PREDICT AN UPGRADE IN GLEASON SCORE BETWEEN INITIAL PROSTATE BIOPSY AND PROSTATECTOMY DIMINISHES WITH INCREASING TUMOUR GRADE DUE TO LOWER LEVELS OF PSA SECRETION PER UNIT TUMOUR VOLUME (2011)

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111096 THE ABILITY OF PSA DENSITY TO PREDICT AN UPGRADE IN GLEASON SCORE BETWEEN INITIAL PROSTATE BIOPSY AND PROSTATECTOMY DIMINISHES WITH INCREASING TUMOUR GRADE DUE TO LOWER LEVELS OF PSA SECRETION PER UNIT TUMOUR VOLUME Niall Corcoran, Chris Hovens, Matthew Hong, Martin Gleave, Anthony Costello, and Larry Goldenberg Niall CorcoranNiall Corcoran Vancouver, Canada More articles by this author , Chris HovensChris Hovens Melbourne, Australia More articles by this author , Matthew HongMatthew Hong Melbourne, Australia More articles by this author , Martin GleaveMartin Gleave Vancouver, Canada More articles by this author , Anthony CostelloAnthony Costello Melbourne, Australia More articles by this author , and Larry GoldenbergLarry Goldenberg Vancouver, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2599AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We and others have shown that an upgrade in Gleason score (GS) between initial prostate biopsy and final prostatectomy pathology is a significant risk factor for recurrence following local therapy. Recently, PSA density (PSAd) has been shown to be a strong predictor of GS upgrade. We analyzed its performance in a large cohort stratified by GS. METHODS Patients undergoing prostatectomy with matching biopsy information were identified from two prospective databases. Patients were analyzed according to the concordance between biopsy and final pathology GS in three paired groups: 6/>6, 3+4/>3+4, 7/>7. Receiver-operator curves (ROC) were generated stratified by GS, and the area under the curve (AUC) calculated. Logistic regression models were fitted to identify significant predictors of tumor upgrade. Tumor volumes were calculated by computer image analysis. RESULTS From 1516 patients, 435 (29%) experienced an upgrade in GS. ROC analysis revealed a decline in AUC with increasing biopsy GS, from 0.64 for biopsy GS=6, to 0.57 for GS=7. In logistic regression models containing pre-treatment variables such as clinical stage and percent positive biopsy cores, for GS=6 and GS=3+4, PSAd was strong predictor of subsequent tumor upgrade (HR= 44.6, 5.1–390.9, p=0.001; HR=16, 2.3–112.5, p=0.005 respectively). Surprisingly, in tumors upgraded from GS=7 to >7, PSAd was not predictive even on univariate analysis, whereas clinical stage and number of positive cores were significant independent predictors. To explore the relationship between serum PSA and GS, tumor volume was calculated in 669 patients. There was a strong association between GS and tumor volume, with the median volume of GS=7 and GS>7 tumors being approximately twice and four times that of GS=6 tumors respectively (p<0.001). In contrast, the median serum PSA per cc tumor volume decreased significantly with increasing grade, from 5.4 ng/ml for GS=6 to 2.1 ng/ml for GS>7 (p<0.001). CONCLUSIONS There is a strong correlation between GS and tumor volume. As well/intermediate differentiated tumors produce relatively high amounts of PSA per unit volume of cancer, high PSA density is a strong and reliable predictor of tumor undergrading. However, as higher-grade tumors produce less PSA per unit volume, PSAd loses its predictive ability, and other clinical markers of tumor volume such as palpable disease and numbers of positive cores become more predictive. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e441 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Niall Corcoran Vancouver, Canada More articles by this author Chris Hovens Melbourne, Australia More articles by this author Matthew Hong Melbourne, Australia More articles by this author Martin Gleave Vancouver, Canada More articles by this author Anthony Costello Melbourne, Australia More articles by this author Larry Goldenberg Vancouver, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...