Correlation of prostate-specific antigen levels with Gleason score and tumor percentage on prostate needle biopsy in prostate cancer

ABSTRACT Introduction: Prostate-specific antigen (PSA) plays an important role in the detection of prostate cancer. Although it has high sensitivity and low specificity, it is still used clinically. A biopsy is recommended if any abnormality is detected in PSA or digital rectal examination (DRE). Materials and Methods: Forty cases diagnosed as prostatic adenocarcinoma out of 109 biopsies submitted were included in the two-year duration study. The clinical parameters (age and serum PSA levels) and histopathological parameters (number of positive cores, tumor percentage, Gleason grade and score, glomeruloid architecture, and perineural and lymphovascular invasion) are noted. Results: The age of the patients ranged from 33 to 98 years with a mean age of 67.5 years. The PSA levels ranged from 1.5 to 381.2 ng/mL. Four cases (10%) showed a lower PSA level of <4 ng/mL. Fourteen cases (35%) showed a Gleason grade of 3 + 3. Ten cases (25%) had a tumor volume between 31 and 40%. Perineural invasion and lymphovascular invasion were seen in 13 (32.5%) and 4 (10%) cases, respectively. A weak correlation was seen between PSA levels and Gleason score ( r = 0.243). No correlation was seen between PSA levels and tumor volume ( r = 0.01). A moderate correlation was noted between the Gleason score and tumor volume ( r = 0.629). Conclusion: Prostate cancer detected by biopsies is not uncommon with PSA levels of 4.0 ng/mL or less. Prevalence of prostate cancer is 36.6%. A weak correlation was seen between PSA levels and the Gleason score. Radical prostatectomies are required to compare pre-operative Gleason score and tumor percentage with post-operative Gleason score and tumor volume.