PROSTATE CANCER

CORRELATION OF GLEASON’S SCORE AND PRETREATMENT PROSTATE SPECIFIC ANTIGEN IN PATIENTS

Abstract

Objectives: To correlate histopathological grades of prostate cancer by Gleason’s scoring system and pretreatment PSA levels in patients with prostate cancer. Study Design: A prospective longitudinal study. Setting: Muhimbili National Hospital in the Departments of Histopathology and Morbid anatomy, Surgery and Biochemistry. Study Period: 15 months (from November 2006 to March 2008). Patients and Methods: Tissues were obtained from 131 cases of Transurethral Trucut biopsy and were formalin fixed and paraffin-embedded for diagnosis. The prostatic tumours were diagnosed and assigned Gleason’s histopathological grades and scores using Haematoxylin and Eosin (H&E) stained sections. Blood for PSA assay was analyzed by a method based on the immunoradiometric principle in which two monoclonal antibodies are directed against two different epitopes of PSA molecule. Results: During the period of study, 113 patients were diagnosed to have carcinoma of the prostate. The mean age at diagnosis was 68 years. The predominant histological type was adenocarcinoma (99.1%). The majority (45.1%) had moderately differentiated adenocarcinoma. Sixty one percent (61%) of patients had Gleason’s score of 5-7 and 81.5% of patients had significant elevation of pretreatment PSA of > 20.0 ng/ml. There was a positive correlation between Gleason’s score and pretreatment PSA levels in patients with Prostate cancer (r = +0.6) and was statistically significant (P< 0.05). Conclusions: It is known that the intermediate (5-7) Gleason’s score prostatic cancers are highly unpredictable in their clinical aggressiveness. This limitation is of particular importance as the majority of the tumours (76%) in our study fell into this intermediate category. Thus, predicting the biological potential of the majority of prostatic cancers in asymptomatic patients based upon histology alone is problematic. The combination of pretreatment PSA levels which correlated well with Gleason’s score in our study will be helpful in planning the choice of therapy in most patients with prostatic cancer in order to improve the prognosis.