Abstract

Objectives: Prostate cancer must be organ-confined to achieve the best results in radical prostatectomy. This study has been designed to investigate the relation of pre-operative free/total PSA ratio with the post-operative pathologic features (stage, surgical margin positivity, seminal vesicle involvement, perineural invasion, multifocality).

Materials and Methods: 46 patients who have undergone radical prostatectomy for prostate cancer between 1998 and 2002 have been retrospectively analyzed. The pathologic evaluation has revealed that 34 (73.9%) cases were organ confined, 12 (26.1%) cases had extraprostatic extention and surgical margins were positive in 7 (15.2%) cases. Seminal vesicle involvement was observed in 7 (15.2%) cases and in 39 (84.8%) cases the seminal vesicles were not involved. Perineural invasion was encountered in 19 (41.3%) cases. The efficiency of pre-operative free/total PSA in predicting the post-operative pathologic features in the above mentioned group of patients has been investigated in this study.

Results: The relation of pre-operative free/total PSA with the pathological stage of the tumor has been found to be statistically insignificant (p>0.05). No correlation has been found between the pre-operative free/total PSA ratio and seminal vesicle involvement, neural invasion status, multifocality and surgical margin positivity (p>0.05 for all of the variables). It was clear that the patients having relatively lower Gleason scores, namely 2-4, 5-6 and 7, had lower pathological stages but the difference was not statistically significant due to the inadequate number of patients having higher Gleason scores of 8-10.

Conclusion: It has been well documented before that PSA and pre-operative Gleason score at biopsy are efficient parameters in predicting the pathological features. This study has revealed that pre-operative free/total PSA does not provide any additional information to the cumulated data in predicting the pathological stage and pathological features.