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
- 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.