title: Nonpalpable stage T1c prostate cancer: prediction of insignificant disease using free/total prostate specific antigen levels and needle biopsy findings.
abstract: OBJECTIVE
  Approximately 25% of radical prostatectomies performed for stage T1c disease show potentially insignificant prostate cancer. We previously reported the use of serum prostate specific antigen (PSA) density and needle biopsy findings to predict potentially insignificant cancer. We now evaluate whether using free/total serum PSA levels along with needle biopsy findings can better predict tumor significance.
  
  
  METHODS
  We studied 163 radical prostatectomy specimens of stage T1c prostate cancer in which free/total serum PSA levels were determined. Free/total serum PSA levels were measured with Tandem-MP PSA assays. Insignificant prostate cancers were organ confined with tumor volumes less than 0.5 cc and Gleason score less than 7. Advanced tumors were either Gleason score 7 or greater, established extraprostatic extension with positive margins, or positive seminal vesicles or lymph nodes. Other cases were considered as moderate tumor. Moderate and advanced tumors were considered significant.
  
  
  RESULTS
  Of the tumors 30.7% were insignificant, 49.7% moderate and 19.6% advanced. The best model to predict preoperatively insignificant tumor was a free/total PSA of 0.15 or greater and favorable needle biopsy findings (less than 3 cores involved, none of the cores with greater than 50% tumor involvement and Gleason score less than 7). Using this model of the 18 tumors predicted to be insignificant 17 were insignificant for a positive predictive value of 94.4%. Of the 145 cases that were predicted to be significant 112 were correctly predicted for a negative predictive value of 77.2%. There was only 1 tumor predicted to be insignificant which was classified as moderate. No tumor predicted to be insignificant was advanced.
  
  
  CONCLUSIONS
  In conjunction with needle biopsy findings, free/total PSA levels accurately predict insignificant tumor in stage T1c disease.
authors.affiliation: Department of Urology, The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
authors.forename: J I
authors.initials: JI
authors.lastname: Epstein
authors.forename: D W
authors.initials: DW
authors.lastname: Chan
authors.forename: L J
authors.initials: LJ
authors.lastname: Sokoll
authors.forename: P C
authors.initials: PC
authors.lastname: Walsh
authors.forename: J L
authors.initials: JL
authors.lastname: Cox
authors.forename: H
authors.initials: H
authors.lastname: Rittenhouse
authors.forename: R
authors.initials: R
authors.lastname: Wolfert
authors.forename: H B
authors.initials: HB
authors.lastname: Carter
mesh_terms: D001707:Biopsy, Needle; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D010173:Palpation; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology*
chemical_list: D017430:Prostate-Specific Antigen