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Case study: management of lymph node-positive disease detected at radical prostatectomy

Prostate Cancer and Prostatic Diseases volume 8, pages 287–289 (2005)Cite this article

Serum PSA screening can detect prostate cancer in asymptomatic men with early localized and, therefore, potentially curable disease. A PSA level >4 ng/ml is considered abnormal for men of any age. However, while at least 25% of men with a PSA level in the 4–10 ng/ml range have prostate cancer,1 the remaining 75% have benign disease. The decision to pursue a biopsy will take into account not only the PSA level, but the patient's age, family history of cancer, and personal circumstances. In this case, prostate biopsy was not undertaken after the first PSA test yielded a result >4 ng/ml (5.1 ng/ml) but delayed until the PSA level was >7 ng/ml. The subsequent diagnostic work-up indicated cT2b prostate cancer (Gleason score 6 (3+3)).

Pretreatment nomograms, such as the Partin tables,2 are an invaluable aid when counseling patients faced with initial treatment decisions for clinically localized prostate cancer. According to the Partin tables,2 this patient, with cT2b disease, a PSA level of 7.3 ng/ml, and a Gleason score of 6, had a 49% chance (95% confidence intervals (CI) 43%, 54%) of having organ-confined disease and a very low risk of lymph node-positive disease (2%, 95% CI 1%, 3%).

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Acknowledgements

Written permission to publish this case was obtained from the patient concerned. Editorial support was provided by Glynis Davies, BSc; financial support for this assistance was provided by AstraZeneca.

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  1. The Prostate Centre, 32 Wimpole Street, London, W1G 8GT, UK

    Roger Kirby

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Correspondence to Roger Kirby.

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Kirby, R. Case study: management of lymph node-positive disease detected at radical prostatectomy. Prostate Cancer Prostatic Dis 8, 287–289 (2005). https://doi.org/10.1038/sj.pcan.4500813

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