Prediction of extraprostatic extension in patients with clinically organ-confined prostate cancer.

INTRODUCTION Preoperative parameters for predicting extraprostatic extension (ECE) in clinically organ-confined prostate cancer patients are not well defined. Our aim was to evaluate the roles of the biopsy Gleason score, prostate-specific antigen (PSA)-based parameters, volume, and clinical T classification in prediction of ECE. MATERIALS AND METHODS A total of 188 patients with clinically organ-confined prostate cancer who underwent radical prostatectomy from January 1998 to December 2007 were included in the study. Age, prostate volume, preoperative total serum PSA (tPSA), free PSA, PSA density (PSAD), biopsy Gleason score, and clinical T classification were analyzed by univariate and multivariate analyses to predict ECE. RESULTS Pathologic examination revealed 130 patients had organ-confined disease and 58 patients were positive for ECE. Multivariate logistic regression analyses showed that tPSA was an independent predictor of ECE. Gleason score ≥8 had a trend for predicting ECE. Receiver operating characteristic (ROC) curves suggested that tPSA and PSAD had a similar diagnosis performance in the whole cohort. For patients with Gleason score of 7, PSAD was found to be statistically better than tPSA for predicting ECE. CONCLUSIONS tPSA remains one of the most important factors for predicting ECE in prostate cancer patients. PSAD may be more helpful than tPSA for predicting ECE in the patients with Gleason score of 7.