Ces Urol 2010, 14(1):48-54 | DOI: 10.48095/cccu2010007

Aggressive prostate cancer in patients with low PSA

Michal Grepl, Milan Král, Eva Burešová, Vladimír Študent

Urologická klinika LF UP a FN, Olomouc

Aim:
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.

Results:
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 Tic 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).

Conclusion:
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.

Keywords: prostate cancer, prostate specific antigen, PSA

Received: August 11, 2009; Accepted: November 11, 2009; Published: January 1, 2010