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N1 Audit of PSA and Gleason scoring in prostatic carcinoma

      Introduction and Objectives

      Every year in the United Kingdom, nearly 32,000 cases of prostate cancer are diagnosed and 10000 deaths are due to it. In a lot of cases, the first sign of the condition is an increase in PSA levels. The diagnosis of prostatic carcinoma is confirmed by histological investigations such as transurethral resection of the prostate (TURP) or on transrectal ultrasound guided needle biopsy. The grading system used for cancer of the prostate is the Gleason grading system (range: 1–5). The Gleason score is the sum of the Gleason grade assigned to the two most common architectural patterns found on biopsy. Therefore the lowest possible score is 2 and the highest being 10. The clinical significance of the score is due to its relation to the patient's survival and therefore is important in the decision making process for the treatment required. Thus the aim of our study was to evaluate the correlation between gleason grading score and PSA level.

      Material and Methods

      In this study, data was reviewed from patients who had a prostatic biopsy for a one-year period. The results were reviewed and only the cases with confirmed adenocarcinoma were selected. In total, 213 patients were included. For each patient, their PSA level prior to the biopsy was noted. Thereafter, an assessment of both PSA levels and histology results was undertaken.

      Results

      The vast majority of patients who were diagnosed with adenocarcinoma of the prostate had a PSA level between 5 and 50. As expected, there was also a pattern showing that the older the patient is the higher his PSA level is. More than half of the patients had a Gleason grading score of 6 and the peak age group was 70–80 years olds. Finally in the comparison between Gleason grading score and PSA level, there was a small positive correlation (r = 0.33, p-value <0.0001) between the two sets of results.

      Conclusions

      Our study showed that there is some discrepancy in the relation between PSA and gleason grading. Therefore we recommend clinicians to assess both sets of results separately.