title: Complexed prostate-specific antigen as a staging tool for prostate cancer: a prospective study in 420 men.
abstract: Over time, the parameters commonly used to predict pathological stage in men with localized prostate cancer have changed, and there is now little stratification in pretreatment prostate-specific antigen (PSA) concentrations, clinical stages, and biopsy Gleason scores. This prospective study evaluated the utility of complexed PSA (cPSA ) for predicting organ-confined disease in a contemporary series of subjects. The age range of the 420 men was 39 to 72 years (58.2 +/- 6 years). Specimens were collected before radical prostatectomy, and total and free PSA (Hybritech Tandem assays, Beckman Access; Beckman Coulter, Inc., Brea, CA) and total and cPSA (Bayer Immuno 1; Bayer Corporation, Tarrytown, NY) were measured. Pathologic stage was determined from the prostatectomy specimen. Of the 420 men, 316 (75%) had organ-confined disease, and 104 (25%) had non-organ-confined disease (20.7% had extraprostatic extension, 2.6% had seminal vesicle involvement, and 1.4% had positive lymph nodes). Prebiopsy Gleason score distribution was as follows: organ-confined organ-confined, 6 (87%) and 7 (10%); non-organ-confined, 6 (66%) and 7 (30%). Of patients with organ-confined disease, 75% had clinical stage T1c disease compared with 56% for non-organ-confined disease. Using univariate logistic regression, the following variables predicted organ-confined disease: biopsy Gleason score, clinical stage, total PSA, percent free PSA, cPSA, percent cPSA (P <0.05). A multivariate model with biopsy Gleason score, clinical stage, and cPSA had a receiver operator characteristic area under the curve of 0.69. Replacing cPSA with total PSA in this model provided similar information. cPSA and total PSA were highly correlated (r = 0.985). In summary, cPSA was equivalent to total PSA in predicting organ-confined disease. Present and future models and nomograms using PSA as an indicator of pathological stage could consider use of cPSA.
authors.affiliation: Department of Pathology, the Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. lsokoll@jhmi.edu
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Sokoll
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Mangold
authors.forename: Alan W
authors.initials: AW
authors.lastname: Partin
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Bruzek
authors.forename: Willard
authors.initials: W
authors.lastname: Dunn
authors.forename: Phaedre
authors.initials: P
authors.lastname: Mohr
authors.forename: Gail
authors.initials: G
authors.lastname: Wallerson
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000379:methods*; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology*; D012372:ROC Curve; D012044:Regression Analysis
chemical_list: D017430:Prostate-Specific Antigen