Prediction of Pelvic Lymph Node Metastases by a Prostate-Specific Antigen and Prostatic Acid Phosphatase in Clinical T3/T4 M0 Prostatic Cancer

Wæhre, Håkon; Wanderaas, Eva Hoff; Paus, Elisabeth; Fosså, Sophie D.

doi:10.1159/000474718

Cited by 15 publications

(5 citation statements)

References 7 publications

(13 reference statements)

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“…In one of our previous studies also creatinine was a significant independent parameter (Fossa et al, 1991). We have no explanation why this parameter was not an independent parameter in the present study except from noting a lower frequency of patients with elevated creatinine, 11%.…”

contrasting

confidence: 71%

“…Several authors have shown that prostate specific antigen (PSA) mirrors the initial tumour burden and the development of the disease during and after primary treatment of prostate cancer (Emtage et al, 1987;Hetherington et al, 1988;Stamey & Kabalin, 1989 (Waehre et al, 1991 The median survival for all patients was 10 months from referral to the NRH and PSA measurement with no significant differences between the four groups ( Figure 1). If Group A was combined with Group D (Figure 2) the survival of Group (A + D) tended to be worse than that for the combined Group (B + C) (P = 0.12).…”

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confidence: 99%

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The prognostic significance of prostate specific antigen in metastatic hormone-resistant prostate cancer

Fosså

Wæhre²,

Paus³

1992

Br J Cancer

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Twenty-seven of 152 patients (18%) with progressing hormone resistant prostate cancer had normal serum levels of prostate specific antigen (PSA less than or equal to 10 micrograms l-1), when referred for secondary treatment. PSA was significantly correlated with the extent of skeletal metastases (R: 0.35) and the levels of hemoglobin (R: -0.19) and serum alkaline phosphatase (R: 0.30). In a multivariate Cox regression analysis the survival of the 152 patients was not correlated with the PSA level but with the patients performance status, the level of hemoglobin, and the time between primary hormone treatment and relapse. The lack of serum PSA to predict survival may be explained by a heterogenous composition of hormone resistant prostate cancer as regards differentiated and/or PSA producing vs undifferentiated and/or PSA non-producing cells.

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confidence: 71%

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confidence: 99%

The prognostic significance of prostate specific antigen in metastatic hormone-resistant prostate cancer

Fosså

Wæhre²,

Paus³

1992

Br J Cancer

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“…The rate of detection of prostate cancer increases to 50–78% in patients with organ‐confined disease when the PSA level and DRE findings are used for diagnosis [ 2–5]. There is a positive correlation of serum PSA level with clinical stage, cancer volume, grade and the presence of metastatic disease [ 6–9]. However, the diagnosis of prostate cancer ultimately requires histological confirmation by prostate biopsy, as several benign factors can contribute to an increased PSA level; hence the diagnostic yield after systematic prostatic biopsy based on an elevated tPSA alone is low [ 10].…”

Section: Introductionmentioning

confidence: 99%

The value of prostate specific antigen (PSA) density and free: total PSA ratio in selecting patients with a normal digital rectal examination and intermediate total PSA levels for further investigation

Klingler

Woo

Rosario

et al. 1998

British Journal of Urology

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Objectives To examine the use of prostate‐specific antigen (PSA) density (PSAD) and free to total PSA ratio (f/tPSA) in enhancing the specificity of PSA in the diagnosis of prostate cancer in patients with a total PSA (tPSA) of 4–10 ng/mL and with a normal digital rectal examination (DRE). Patients and methods The study comprised 77 consecutive men in whom the fPSA and tPSA levels were obtained before DRE and transrectal ultrasonography‐guided sextant prostate biopsy. Prostate cancer was found in 39 patients and the histology was benign in 38. Receiver operator characteristic curves, obtained from all 77 patients, were used to determine the optimal thresholds for PSAD and f/tPSA in detecting cancer. A subset of 28 patients, including seven with prostate cancer, was identified who had a normal DRE and a tPSA of 4–10 ng/mL; PSAD and f/tPSA values were applied at the optimal thresholds to assess their use in identifying those patients with cancer. Results When applied to the selected group of 28 patients, the PSAD (threshold 0.15) failed to identify any with prostate cancer. The f/tPSA (threshold 0.12) yielded a sensitivity of 65% and a specificity of 38%, identifying only three of seven patients with cancer. By increasing the threshold to 0.25, six patients were correctly identified, giving a sensitivity of 86%, with a lower specificity of 14%. Conclusions These findings suggest that the neither PSAD nor f/tPSA either significantly reduce the negative biopsy rate or identify patients at greater risk of prostate cancer, particularly when the tPSA is equivocal at 4–10 ng/mL.

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“…Between 1987 and 1993 all patients had their serum PSA levels determined at referral and immediately before radiotherapy, using either the Hybritech Tandem‐PSA method (Hybritech Corp, USA) or by a laboratory‐developed assay that was comparable with that technique [16]. From 1993 to 1997 an immunofluorometric assay for total PSA, based on time‐resolved fluorescence, was established in our laboratory.…”

Section: Methodsmentioning

confidence: 99%

The immunohistochemical assessment of occult regional lymph node metastases in patients with T3pN0M0 prostate cancer before definitive radiotherapy

Clobes¹,

Fosså²,

Wæhre

et al. 2000

BJU International

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Objective To detect occult regional lymph node metastases in patients with T3pN0M0 prostate cancer not recognized by routine haematoxylin and eosin staining, and to evaluate the clinical relevance of this ®nding. Patients and methods Formalin-®xed and paraf®n-embedded pelvic lymph nodes (1118) from 92 patients were evaluated by immunohistochemistry using antibodies for prostate speci®c antigen (PSA) and pancytokeratin (AE1/AE3). Of the tumours, 14% were well, 69% moderately and 17% poorly differentiated. The extent of tumour was categorized as T3pN0M0 in all patients, who were referred for de®nitive radiotherapy after pelvic staging lymphadenectomy. The median (range) serum PSA value before treatment was 18.5 (0.4±342) mg/L. After radiotherapy, the patients were followed by assessing biochemical progression, pelvic recurrence and/or development of distant metastases. The median (range) observation time for all patients was 61 (16±136) months.Results Occult lymph node metastases were detected in four (4.4%) of the 92 patients. Patients with or without occult metastases had similar serum PSA levels and histological grades. None of the four patients with occult metastases progressed, compared with 37 of the 88 (42%) with no such metastases. Conclusion Using immunohistochemistry the detection rate of occult lymph node metastases in patients with T3pN0M0 prostate cancer is low. The occurrence of such metastases is probably unrelated to the serum PSA value before treatment. The short-term outcome of patients subsequently treated with de®nitive radiotherapy does not seem to be associated with the ®nding of occult lymph node metastases, but longterm follow-up is needed. So far, the results do not justify the search for occult lymph node metastases as a routine procedure in these patients

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Prediction of Pelvic Lymph Node Metastases by a Prostate-Specific Antigen and Prostatic Acid Phosphatase in Clinical T3/T4 M0 Prostatic Cancer

Cited by 15 publications

References 7 publications

The prognostic significance of prostate specific antigen in metastatic hormone-resistant prostate cancer

The prognostic significance of prostate specific antigen in metastatic hormone-resistant prostate cancer

The value of prostate specific antigen (PSA) density and free: total PSA ratio in selecting patients with a normal digital rectal examination and intermediate total PSA levels for further investigation

The immunohistochemical assessment of occult regional lymph node metastases in patients with T3pN0M0 prostate cancer before definitive radiotherapy

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