The Value Of Prostate-specific Antigen Density (PSAD) To Predict An Upgrade In Gleason Score For Prostate Biopsy

Objective:To investigate the performance of prostate specific antigen density (PSAD) as a predictor of Gleason score upgrade between initial prostate biopsy and radical prostatectomy (RP) in the patients with low or intermediate risk prostate cancers (PCa).Methods:This study comprised a retrospective analysis of data from170PCa patients (PSA<20μg/L, stage≤T2b, Gleason score≤7). The median age was68years, the median PSA was10.2μg/L, the median PSAD was0.35mg/L2and the median prostate volume was28.4ml. There were95cases in cT1stage and75cases in cT2stage. According to biopsy Gleason score patients were divided into three groups:3+3(91cases),3+4(42cases) and4+3(37cases). Each group was further stratified into to subgroups according to whether their RP Gleason score was concordant or upgraded. Receiver-operating characteristic (ROC) curves for predictive power of PSAD were generated for each group, and the area under the curve (AUC) was calculated. Results:From170patients,79(46.5%) had an upgrade in Gleason score, of which51(56.0%) were in3+3group,17(40.5%) were in3+4group,11(29.7%) were in4+3group. In the3+3group, PSAD was significantly higher in subgroup with upgraded Gleason score compared with the subgroup of concordant Gleason score (0.37mg/L2v.s.0.23mg/L2, P<0.01).In the other two groups, PSAD were not of significant differences between subgroup with upgraded Gleason score and the subgroup of concordant Gleason score (0.33mg/L2v.s.0.36mg/L2,0.49mg/L2v.s.0.58mg/L2, P>0.05).ROC analysis showed a decline in AUC with increasing biopsy Gleason score. It was0.762for3+3group,0.529for3+4group and0.413for4+3group. The pathologic stage in upgraded cases were more advanced in all the groups(P<0.05).Conclusions:PSAD has the ability of predicting Gleason score upgrade after RP in the biopsy Gleason score3+3PCa patients whose clinical risk stratification are low or intermediate.