Prostate cancer is the most common cancer in men. Although the prostate-specific antigen (PSA) is still used as a diagnostic and screening test, there are some controversies about its performance for the differentiation of high-risk cancer from low-risk cancer at an early stage. The Gleason grading system for the pathological grading of prostatic adenocarcinoma is based on the architectural patterns of prostatic glands and it is one of the major predictors of prostate cancer prognosis and clinical management. This study aimed to investigate the concordance between histopathological prognostic findings from prostate needle biopsy samples and serum PSA levels. This retrospective study included data from 150 patients with histopathologically diagnosed as prostatic adenocarcinoma. All patients underwent multi-core transrectal ultrasound-guided prostate needle biopsy because of elevated PSA. Pathological data were classified as high-grade (≥7, 4+3) and low-grade (≤7, 3+4) based on the Gleason score values. Laboratory data were classified as high-risk (>10 ng/mL) and low-risk (≤10 ng/mL) based on the PSA levels. Ninety three (62%) patients had PSA >10 ng/mL. Seventy patients (46.7%) had Gleason score ≥7 (4+3). Age, tumor volume, PSA levels, and the number of tumor-positive cores were significantly higher in the tumors with Gleason score ≥7 (4+3). Tumor volume, Gleason score, and the number of tumor-positive cores were significantly higher in the tumors with PSA >10 ng/mL. Lymphovascular invasion (LVI) and perineural invasion (PNI) positivity were more often in the high-grade and high-risk tumors. Age, tumor volume, PSA, and the number of tumor-positive cores showed a significant positive correlation with the Gleason score and tumor volume. The cut-off values of PSA (Gleason score ≤7 vs ≥7) was 15.45 ng/mL with AUC=0.882 (95% confidence interval, CI: 0.82 to 0.94), sensitivity was 87% (95% CI: 0.76 to 0.94), specificity was 81% (95% CI: 0.69 to 0.88), and likelihood ratio was 4.4.
Key words: Biopsy, needle, neoplasm grading, pathology, prostatic neoplasms, prostate-specific antigen