title: Prediction of the extent of prostate cancer by the combined use of systematic biopsy and serum level of cathepsin D.
abstract: BACKGROUND
  The objective of this study was to assess the usefulness of combined systematic prostate biopsy with the serum level of cathepsin D, which has recently been shown to be a useful marker for prostate cancer, to predict the disease extension.
  
  
  METHODS
  Seventy-two patients with clinically organ-confined disease who underwent radical prostatectomy were evaluated for serum prostate-specific antigen (PSA) and cathepsin D levels, systematic biopsy, and pathological stage.
  
  
  RESULTS
  The incidence of extraprostatic disease in patients with more than half the biopsy cores positive or > or = 15 ng/mL cathepsin D was significantly higher than that in patients with less than half the biopsy cores positive or < 15 ng/mL cathepsin D, respectively; whereas cancer in bilateral lobes or > or = 10 ng/mL PSA could not be used as a predictor of extraprostatic disease. Furthermore, in patients with more than half the biopsy cores positive and > or = 15 ng/mL cathepsin D or those with more than half the biopsy cores positive and > or = 10 ng/mL PSA, extraprostatic disease was significantly more common than in those with less than half the biopsy cores positive and < 15 ng/mL cathepsin D or those with less than half the biopsy cores positive and < 10 ng/mL PSA, respectively. Furthermore, the prediction of the incidence of extraprostatic disease using these three variables was significantly more accurate than using two of the variables (percentage positive biopsy cores plus serum cathepsin D or PSA).
  
  
  CONCLUSIONS
  Systematic biopsy together with serum cathepsin D and/or PSA was a useful predictor of the extent of prostate cancer. Patients with more than half the biopsy cores positive, > or = 15 ng/mL cathepsin D and/or > or = 10 ng/mL PSA could avoid prostatectomy because there is a significantly high probability that they already have extraprostatic disease.
authors.affiliation: Department of Urology, Hyogo Medical Center for Adults, 13-70 Kitaohji-cho, Akashi 673-8558, Japan. hideakimiyake@hotmail.com
authors.forename: Hideaki
authors.initials: H
authors.lastname: Miyake
authors.forename: Isao
authors.initials: I
authors.lastname: Hara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Eto
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D001707:Biopsy, Needle / Q000379:methods; D002402:Cathepsin D / Q000097:blood*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen; D002402:Cathepsin D