Aggressive prostate cancer in patients with low PSA

Authors: Michal Grepl;  Milan Král;  Eva Burešová;  Vladimír Študent
Authors‘ workplace: Urologická klinika LF UP a FN, Olomouc
Published in: Ces Urol 2010; 14(1): 48-54
Category: Original article


To investigate prevalence and characteristics of the prostate cancer in men with total PSA < 4 ng/ml.

Material and methods:
We evaluated 731 men with consecutive multiplicated prostate biopsies. Indication criteria for biopsy were elevation of age-specific PSA, increasing PSA velocity or suspicious digital rectal examination.

Together 202 patients underwent prostate biopsy with PSA < 4 ng/ml. In the group with low PSA the prevalence of prostate cancer was 18,8% and in the group with PSA > 4 ng/ml the prevalence was 30.7% (p < 0.001). Acinar adenocarcinoma was described in all positive samples. After biopsy 57.8% of carcinomas were T1c stage, 36.8% were T2a–b and 5.4% were suspicious for T3a–b. Gleason score (GS) 2+3 or 3+3 were described in 65.8%, GS 7 in 26.3% and GS 8 and more in 7.9% of positive samples. In men after radical prostatectomy there were 75.8% of localized diseases and 24.2% of advanced diseases. In 9.7% we have found metastatic affection of lymph nodes or axial skelet. Upstage was nearly non-significant (p = 0.06). In these definitive specimens GS 6 was described in 32.2%, GS 7 in 50% and GS > 8 in 27.8%. Impairment of Gleason score was significant (p = 0.005).

In the group of patients with prostate cancer and PSA < 4 ng/ml only 23.6% met the criteria for insignificant disease. In 76.4% cases we found potentially aggressive carcinomas and nearly quarter (24.2%) of cancers was advanced or metastatic.

Key words:
prostate cancer, prostate specific antigen, PSA.


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Paediatric urologist Nephrology Urology
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