Predictive values for extracapsular extension in prostate cancer patients with PSA values below 10 ng/mL

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Prostate cancer (PCa) management often relies on preoperative assessment.
• Extracapsular extension (ECE) is a critical factor influencing treatment decisions and prognosis.
• Accurate prediction of ECE in patients with prostate-specific antigen (PSA) below 10 ng/mL is challenging but essential.

Purpose of the Study:

• To evaluate the predictive value of various clinical and pathological parameters for extracapsular extension (ECE) in prostate cancer (PCa) patients.
• To identify key indicators for ECE in patients undergoing radical retropubic prostatectomy (RRP) with PSA levels under 10 ng/mL.

Main Methods:

• Retrospective analysis of 167 patients who underwent RRP with PSA < 10 ng/mL.
• Comparison of clinicopathological variables including PSA, PSA density, digital rectal examination (DRE), biopsy Gleason score, perineural invasion (PNI), and lymphovascular invasion (LVI) between groups with and without ECE.

Main Results:

• ECE was identified in 26.9% of patients.
• PSA density (p=0.03) and biopsy Gleason score (p=0.04) showed statistically significant differences between groups.
• Lymphovascular invasion (PNI and LVI) was significantly higher in patients with ECE (p=0.002).

Conclusions:

• PSA density, lymphovascular invasion, and biopsy Gleason total score are significant predictors of ECE in PCa patients with PSA < 10 ng/mL.
• These parameters should be incorporated into the preoperative evaluation for improved risk stratification.
• Enhanced preoperative assessment can optimize surgical planning and patient counseling.