[Preoperative assessment of tumor aggressiveness in localized prostatic carcinoma]

In 106 consecutive patients with localized prostate cancer digital rectal examination (DRE), preoperative prostate-specific antigen (PSA) determination and results of systematic sextant biopsies (TRUS 6Bx) of the prostate were analyzed for their value in the estimation of the aggressivity of tumors. In all patients with negative pelvic lymph nodes radical retropubic prostatectomy was performed. Tumor aggressiveness was defined as capsular penetration (pT2 versus pT3) or positive surgical margins in patients with pT3 tumors. Neither DRE nor preoperative PSA level was helpful in predicting capsular penetration or positive surgical margins. However, the number of positive core biopsies and the identification of Gleason 4 or 5 tumors within positive biopsy specimens correlated with capsular penetration and positive surgical margins. These results can be used to create a score, based on DRE, PSA, TRUS 6Bx, and Gleason 4 or 5, that might be helpful in predicting tumour aggressivity in patients with localized prostate cancer.