Serum prostate-specific antigen, clinical stage, pathologic grade, and the incidence of nodal metastases in prostate cancer

M. Elizabeth Sands, Gunar K. Zagars, Alan Pollack, Andrew Von Eschenbach

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)215-220
Number of pages6
JournalUrology
Volume44
Issue number2
DOIs
StatePublished - Jan 1 1994
Externally publishedYes

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Prostate-Specific Antigen
Prostatic Neoplasms
Neoplasm Metastasis
Incidence
Serum
Lymph Node Excision
varespladib methyl
Logistic Models
Neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Serum prostate-specific antigen, clinical stage, pathologic grade, and the incidence of nodal metastases in prostate cancer. / Elizabeth Sands, M.; Zagars, Gunar K.; Pollack, Alan; Von Eschenbach, Andrew.

In: Urology, Vol. 44, No. 2, 01.01.1994, p. 215-220.

Research output: Contribution to journalArticle

Elizabeth Sands, M. ; Zagars, Gunar K. ; Pollack, Alan ; Von Eschenbach, Andrew. / Serum prostate-specific antigen, clinical stage, pathologic grade, and the incidence of nodal metastases in prostate cancer. In: Urology. 1994 ; Vol. 44, No. 2. pp. 215-220.
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abstract = "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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T1 - Serum prostate-specific antigen, clinical stage, pathologic grade, and the incidence of nodal metastases in prostate cancer

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AU - Zagars, Gunar K.

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N2 - 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.

AB - 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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