Objectives: To evaluate the potential gains in using serum prostate-specific antigen ( PSA) levels for predicting the incidence of pelvic nodal metastases in patients with otherwise localized prostate cancer. Methods: We reviewed 569 patients undergoing staging lymphadenectomy, and evaluatedthe correlation between clinical stage, tumor grade, presurgical PSA level, and the incidence of nodal metastatic disease using univariate and multivariate regression. Results: In univariate analysis stage, grade, and PSA level were highly significant covariates with nodal metastasis. Nodal metastatic rates increased as stage increased: Stage T1 (A2), 6 of 127 (5%); Stage T2 (B), 41 of 243 (17%); Stage T3 (C), 95 of 199 (48%), (p < 0.0001). Likewise metastatic rates increased as grade increased: Gleason grades 2 to 4, 6 of 124 (5%); Gleasoh grades 5 and 6, 52 of 238 (22%); Gleason grade 7, 41 of 122 (34%); Gleasoh grades 8 to 10, 43 of 84 (51 %) (p < 0.0001). The relationship between PSA level and nodal metastases was not linear and we selected the following groupings that correlated with nodal disease: 4 or less ng/mL, 4 of 104 (4%); more than 4 to 20 or less ng/mL, 73 of 335 (22%); more than 20 to 40 or less ng/mL, 35 of 85 (41 %); more than 40 ng/mL, 30 of 45 (67%) (p < 0.0001). Using multivariate logistic regression, stage, grade, and PSA were independently predictive of nodal status. Conclusions: The gains in predictive accuracy from PSA beyond that obtained from stage and grade were small and in practice would benefit fewer than 15% of our patients. Staging pelvic lymphadenectomy remains the only satisfactory method for elucidating nodal status in the majority of patients with prostate cancer.
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