Relationship between serum prostate specific antigen, needle biopsy findings, and histopathologic features of prostatic carcinoma in radical prostatectomy tissues

Background. Adenocarcinoma of the prostate exhibits a wide range of biologic behavior, from small, well differentiated tumors found at postmortem examination to large, poorly differentiated cancers that may cause mortality. The pretreatment prediction of those carcinomas of the prostate that are likely to be clinically aggressive is an important objective. Methods. The pretreatment parameters of serum prostate specific antigen (PSA), PSA density (PSAD), and needle biopsy features of carcinoma, including number of positive biopsy results, percentage of positive biopsy results, millimeters of carcinoma, percentage of carcinoma in biopsy tissue, and histologic grade, were related to histopathologic features of prostate cancer in 50 completely embedded radical prostatectomy specimens. Step-wise multiple variable regression analysis was used to determine which of these parameters exhibited significant, independent value in the prediction of tumor grade, volume, and stage in the whole gland. Results. PSAD and histologic grade in needle biopsy were significantly related to histologic grade in the whole prostate gland. PSA, PSAD, and number of needle biopsies with carcinoma were significant predictors of tumor size (volume) in the whole gland. However, pretreatment parameters did not achieve significance in the prediction of pathologic stage, and it was not possible to predict potentially clinically insignificant tumor size of less than 0.5 cc based on these parameters. Conclusions. Significant pretreatment indicators of potentially aggressive prostate cancer include serum PSA, PSAD, histologic grade in needle biopsy, and number of needle biopsies with carcinoma. However, due to scatter of data points, it may be difficult to absolutely predict outcome for the individual patient based on pretreatment serum PSA, PSAD, and needle biopsy findings. Cancer 1995;75:1842–9.