Improved Preoperative Staging of Prostate Cancer: Predicting How Far it's Spread
Three factors independently help to predict the extent of prostate cancer in any individual patient: PSA, Gleason score, clinical stage. Recently, we demonstrated that all 3 of these factors are inter-related. For example, there is more PSA produced pet gram of well differentiated cancer (Gleason score 2-6) than by poorly differentiated cancer (Gleason 7 or greater). Therefore, to evaluate the significance of a serum PSA level in any one patient, you also need to know his Gleason score. Furthermore, there is a strong association between the extent of the tumor, the serum PSA, and the clinical stage of the disease, e.g. stage A-D in the old classification or stage T I -T4 in the new TNM classification.
We have recently developed nomograms that correlate the level of serum PSA with the Gleason score and clinical stage in individual patients. These nomograms are very useful in predicting the extent of the cancer and therefore the type of treatment best suited for individual patients.
- Partin, A.W., Yoo, J., Carter, H.B., Pearson, J.D., Chan, D.W., Epstein, J.1., and Walih, P.C.: The use of prostate specific antigen, clinical stage and Gleason score to predict pathological stage in men with localized prostate cancer. J. Urol. 150:110-114, 1993.