Prognostic implications of preoperative diagnosis of clinically local and locally advanced prostatic cancer

The data of preoperative diagnosis and morphological examination were compared for 144 patients with prostatic carcinoma T1-4N0-XM0 subjected to radical prostatectomy in 1997-2007. In assessment of prostatic capsule invasion, sensitivity of the rectal examination was 21.7%, specificity - 89.8%, diagnostic efficacy - 68.1%, PPV - 50.0%, NPV - 70.9%, AUC under ROC curve - 0.558 ± 0.053 (p = 0.348); sensitivity of transrectal ultrasonic investigation - 21.7%, specificity - 89.8%, diagnostic efficacy - 68.8%, PPV - 52.6%, NPV - 71.2%, AUC under ROC curve - 0.563 ± 0.053 (p = 0.211). Factors of a poor prognosis of prostatic capsule invasion were PSA > 10 ng/ml (p = 0.028) and Gleason score > 7 (p = 0.052). Combined use of these two parameters raises quality of preoperative assessment of category T [sensitivity - 80.0%, specificity - 55.1%, diagnostic efficacy - 56.3%, PPV - 80.4%, NPV - 44.9%, AUC under ROC curve - 0.624 ± 0.049 (p = 0.017)]. Sensitivity of clinical assessment of N category was 11.1% in 100% specificity, 94.4% diagnostic efficacy, 100% PPV, 94.4% NPV, 0.556 ± 0.107 (p = 0.577) AUC under ROC curve. A single significant prognostic factor of pN+ category was PSA > 10 ng/ml (p = 0.014). Sensitivity of histological examination of biopsy material in relation to true Gleasons parameter (<7 or >7) was 59.4%, specificity 89.3%, diagnostic efficacy 82.6%, PPV 61.3%, NPV 88.5%, AUC under ROC curve 0.743 ± 0.056 (p < 0.0001). Thus, combined use of a baseline PSA concentration with a borderline value > 10 ng/ml and biopsy Gleason score > 7 raises quality of preoperative evaluation of extraprostatic tumor extension and condition of regional lymph nodes.