The proportion of free PSA and upgrading of biopsy Gleason score after radical prostatectomy

Abstract

Introduction: Upgrading of biopsy Gleason score (GS) after radical prostatectomy (RP) to GS >or=7 is common in patients with low-grade prostate cancer in biopsy. We evaluated whether a low proportion of free PSA (%fPSA) and total PSA (tPSA) predict significant upgrading after RP.

Patients and methods: 122 patients with biopsy GS 5 or 6 prostate cancer and a tPSA <10 ng/ml who underwent RP in our academic center were included in the study. The utility of prebiopsy %fPSA and tPSA as predictors of significant upgrading was evaluated.

Results: Among patients undergoing RP, upgrading to GS >or=7 was found in 61 of 122 (50%) patients. A low %fPSA was a predictor of significant upgrading of tumors with biopsy GS 5 or 6 prostate cancer in patients with tPSA <10 ng/ml.

Conclusions: Our results suggest that the selection of prostate cancer patients for active surveillance or re-biopsy may be improved by using %fPSA as a predictor of significant upgrading.