PROGNOSTIC FACTORS OF EXTRACAPSULAR EXTENSION IN PATIENTS WITH PROSTATE CANCER

Al-Shukri S.H.^*, Borovets S. JU.^*

ABSTRACT

Background: indications to radical prostatectomy define on exact staging of prostate cancer. Not reviled extra capsular extension leads to high risk of positive surgical margin, recurrence of tumor and metastasis with poor prognosis.

Objective: 125 patients with clinically localized intraprostatic carcinoma were evaluated (49-71 years old, mean 61.5±0.4 years).

Methods: Serum PSA determination, transrectal ultrasound with multifocal prostate biopsy were carried out. Grade of Gleason's score malignancy was defended after preoperative multifocal prostate biopsy and postoperative morphological investigation. Open radical retro pubic prostatectomy was performed in our clinic for all 125 patients during 1996 - 2003.

Results: preoperative risk factors for extra capsular extension were revealed: clinical stage of prostate cancer higher than T2a (F=17,34; p=0,0002); grade of Gleason's score more than 6 points (after multifocal prostate biopsy) (F=24,18; p<0,0001); serum PSA higher than 10 ng/ml (F=22,53; P<0,0001); number of positive (with prostate cancer cells) bioptic columns more than 2 (F=20,12; P<0,005); presents of perineural prostate invasion (F=18,45; p<0,001); patients age less than 50 y.o. (F=16,02; p=0,0003). On the base of this data using discriminant multifactor analysis the following model of extracapsular extension prediction was created.

D= - 0,72xA + 0,08xT + 0,08xG + 0,05xB + 8,0xPSA + 0,47xI, where: D-probability of prostate   extracapsular   extension   (discriminated function); A - patients age, years (1 - less than 50; 2 -50-60; 3 - more than 60); T-clinical stage, T(1-T2a, 2-T2b, 3-T3a, 4-T3b); G-Gleason's score grade of malignancy (preoperative multifocal prostate biopsy) (2-10 points); В-number of positive bioptic columns (1-10); PSA-level of serum PSA higher than 10 ng/ml (0-no; 1-yes); I-perineural tumor invasion (0-no; 1-yes). If D <or= 0, 25-low risk of extracapsular extension; if D > 0,25-high risk of extracapsular extension. Method's sensitivity-71,4%, specificity-93%, positive result prediction value - 38,5%, negative result prediction value - 98,1%, total prediction value -91,7% (A = 0,64; p<0,00001).

Conclusion: rise of extracapsular prostatic extension depends on different preoperative clinical and morphological factors. Created multifactor model allows predicting of locally advanced prostate cancer

*Department:  Urology

Qualification: Dr. of Medicine

Specialty:  Urologist

Address:   Department of Urology, Lva Tolstogo str. 6/8, 197022, St.-Petersburg, Russia

 E-mail:    sborovets@mail.ru