COMPARISON OF PREOPERATIVE AND POSTOPERATIVE STAGE AND GRADE OF PROSTATE CARCINOMA IN PATIENTS WITH PSA LEVEL OF 2-10 NG/ML

Summary Patients are selected for radical prostatectomy with a disease limited to the organ, satisfying general condition and enough long life expectancy. Postsurgical findings often point out more advanced disease or less differentiated cancer compared to findings upon which an indication for prostatectomy was made, what affects prognosis and points out need for adjuvant treatment. The study is aimed at establishing in what manner the clinical stage and grade of the disease correlate to the definitive histological finding. The investigation was done in 80 patients with histologically proven, clinically organ confirmed prostate cancer, and initial PSA values 2-10 ng/ml, which underwent retro-pubic prostatectomy. Pathohistological analysis of complete resection sample was performed in order to establish spread and differentiation of the tumor. Clinical and pathological stage of the disease, Gleason score and Gleason grade were compared. In 11 patients (14%) extra-prostatic invasion of the disease was found following examination of the obtained slides. After surgery, in a significant number of patients inclusion of both prostate lobes was established, so the number of clinical stage T2b was significantly higher than pT2b (40 compared to 18), and T2c was significantly lower than pT2c (3 compared to 22). The Gleason score was underestimated in 25 (31, 25%) while it was overrated in 2 (2.5%). In more than one-third of patients the bioptical Gleason score was lower than the definitive pathohistologic score of the prostate slide. There is a significant difference between the biopsy and definitive pathohistologic T stage of prostate cancer also in a sense of underestimation. The frequency of established extra-capsular invasion and lymphatic metastasis corresponds to the rates of predictive models (Partin tables). The study did not show extra-capsular invasion in cases of well-differentiated prostate cancer (Gleason score ≤ 6).