Use of prostate-specific antigen, Gleason score, and digital rectal examination in staging patients with newly diagnosed prostate cancer

Urol Clin North Am. 1997 May;24(2):379-88. doi: 10.1016/s0094-0143(05)70384-0.


CT Scan, MR Imaging Scan, and Pedal Lymphangiography. Patients with a PSA greater than 25 ng/mL, a Gleason score greater than 6, and a positive DRE should undergo CT scan with FNA of lymph nodes at least 6 mm in size. Otherwise, CT scan, MR imaging scan, and pelvic lymphangiogram are not indicated. This should eliminate use of these staging studies in over 90% of patients with newly diagnosed adenocarcinoma of the prostate. Pelvic Lymph-Node Dissection. Pelvic lymph-node dissection can be safely eliminated in patients who meet the following predictive criteria: 1. PSA not more than 5 ng/mL or 2. Gleason score not more than 5 or 3. A combination of the following: PSA not more than 25 ng/mL, Gleason score not more than 7, and negative DRE. Following these criteria should eliminate the need for pelvic lymphadenectomy in 60% of patients with newly diagnosed prostate cancer.

Publication types

  • Review

MeSH terms

  • Humans
  • Lymph Nodes / pathology
  • Male
  • Neoplasm Staging
  • Physical Examination*
  • Prostate-Specific Antigen / blood*
  • Prostatic Neoplasms / diagnosis
  • Prostatic Neoplasms / pathology*


  • Prostate-Specific Antigen