Turk Uroloji Dergisi, vol.29, no.2, pp.133-137, 2003 (SCI-Expanded)
Introduction: Initial diagnostic evaluation may provide information about the extent of disease after radical retropubic prostatectomy (RRP). The aim of this study is to investigate the predictive value of various diagnostic studies in determining the extent of disease in radical retropubic prostatectomy specimens. Material and Methods: A retrospective analysis was performed for 157 patients who underwent RRP for organ confined prostate cancer and whose follow-up data was accessible. The correlation of preoperative serum PSA level, local disease extension in TRUS, and Gleason score at TRUS biopsy specimen with postoperative extracapsular extension (EC), seminal vesicle invasion (SV), lymph node involvement (LN) and surgical margin status (SM) on RRP specimens were statistically analyzed. Results: The mean preoperative serum PSA level of all patients was 11.8 (median 8.72) ng/ml. After the evaluation of RRP spesimens, 61 (39%) patients were found to have EC extension, 36 (%23) patients had SV invasion, 7 (0.5%) had LN involvement, and 53 (%34) had positive surgical margin(s). Comparing the preoperative TRUS findings and postoperative evaluation of RRP specimens, the sensitivity of TRUS in predicting the EC extension was 15.4% and specificity was 94.7%. Sensitivity of TRUS in predicting SV invasion was 12.9% and its specificity was 97.9%. The median PSA level was 9 ng/ml. and median Gleason score in TRUS biopsy was 7 in patients with EC extension while median serum PSA level was 6.5 ng/ml (p<0.05) and median Gleason score was 6 (p<0.05) in patients without any EC extension. The median serum PSA level was 9.7 ng/ml and median Gleason score was 7.0 in patients with SV invasion while median serum PSA level was 5.4 ng/ml (p<0.05) and median Gleason score was 6 (p<0.05) in patients without SV invasion. The median PSA level was 15.1 ng/ml and Gleason score was 8.0 in patients with LN involvement while median PSA level was 8.6 ng/ml (p<0.05) and median Gleason score was 6 (p<0.05) in patients without LN involvement. The median PSA level was 14.7 ng/ml and Gleason score was 7.0 in patients with positive SM while median PSA level was 14.2 ng/ml (p<0.05) and median Gleason score was 6 (p<0.05) in patients without positive SM. Conclusions: Gleason score and serum PSA level appears to be the most important predictive factors for extraprostatic disease in RRP specimens.