The role of prostate specific antigen, Gleason score, digital rectal examination, and transrectal ultrasonography in the prediction of extracapsular prostate cancer

Purpose: Definite treatment for localized prostate cancer in the form of radical prostatectomy is most effective when the disease is organ-confined at the time of surgery. Unfortunately, current staging modalities are insufficient and a significant number of patients have pathologically extracapsular disease at operation. Therefore, there is a need for improvement in the interpretation of current preoperative staging procedures. The purpose of this study was to investigate the contribution of some preoperative parameters in the prediction of extracapsular disease. Patients and methods: The records of 71 men who had undergone radical retropubic prostatectomy for clinically localized disease were reviewed. Serum prostatic specific antigen (PSA) and Gleason score, as well as digital rectal examination (DRE) and transrectal ultrasonography (TRUS), were registered and their contribution to the correct preoperative prediction of extracapsular disease was evaluated. Results: The presence of either a serum PSA level of ≥10 ng/ml or a Gleason score ≥7 indicated extracapsular disease with a probability of 77%. Positive DRE and TRUS contributed little to the accurate preoperative local staging. Conclusion: The combination of serum PSA and Gleason score should play an important role in the preoperative decision-making, as they help considerably in the preoperative prediction of the presence of extracapsular disease