title: Pathological features of Gleason score 6 prostate cancers in the low and intermediate range of prostate-specific antigen level: is there a difference?
abstract: OBJECTIVE
  To assess the pathological features of Gleason score 6 prostate cancers after radical prostatectomy in the low (<4 ng/mL) and intermediate range of prostate-specific antigen level (4-10 ng/mL), as such prostate cancers are considered to be well differentiated tumours with a low risk for recurrence after therapy.
  
  
  METHODS
  In all, 1354 patients with T1c prostate cancer and PSA levels of <10.0 ng/mL had a radical retropubic prostatectomy. Patients with Gleason score 6 tumours were divided into two groups, those with PSA levels of <4 and 4.0-10.0 ng/mL. Extracapsular extension, positive surgical margins, biochemical recurrence (BCR) and mean time to BCR were evaluated.
  
  
  RESULTS
  Of the 1354 patients, there were 437 (32.3%) with Gleason score 6 prostate cancers. Patients in the low PSA group had less extraprostatic disease than those with a higher level (5.9% vs 14.5%) and both groups had an almost equal proportion of positive surgical margins (9.4% vs 11.0%). In the low PSA group there was statistically significantly shorter BCR than in the high PSA group, with a mean time to BCR of 1.7 vs 3.1 years.
  
  
  CONCLUSIONS
  These results show a statistically significantly higher rate of extraprostatic disease and earlier BCR in men with a high than a low PSA level even in Gleason score 6 prostate cancer. As the rate of BCR and extracapsular extension are significantly related to prostate cancer mortality, these findings further support the concept of screening using low PSA levels.
authors.affiliation: Department of Urology, University of Innsbruck, Austria. alexandre.pelzer@gmail.com
authors.forename: Alexandre E
authors.initials: AE
authors.lastname: Pelzer
authors.forename: Daniela
authors.initials: D
authors.lastname: Colleselli
authors.forename: Jasmin
authors.initials: J
authors.lastname: Bektic
authors.forename: Eberhard
authors.initials: E
authors.lastname: Steiner
authors.forename: Reinhold
authors.initials: R
authors.lastname: Ramoner
authors.forename: Michael
authors.initials: M
authors.lastname: Mitterberger
authors.forename: Christian
authors.initials: C
authors.lastname: Schwentner
authors.forename: Georg
authors.initials: G
authors.lastname: Schaefer
authors.forename: Stefano
authors.initials: S
authors.lastname: Ongarello
authors.forename: Georg
authors.initials: G
authors.lastname: Bartsch
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Horninger
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging / Q000379:methods; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000378:metabolism*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery
chemical_list: D017430:Prostate-Specific Antigen