Characterizing prostatic adenocarcinomas in men with a serum prostate specific antigen level of <4.0 ng/mL

M. H. Sokoloff*, X. J. Yang, M. Fumo, D. Mhoon, C. B. Brendler

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


OBJECTIVE: To characterize prostate cancer in men undergoing radical prostatectomy who have a prostate-specific antigen (PSA) level of <4.0 ng/mL, hypothesising that a low PSA is not caused by diminished tumour production of PSA, nor does it signify clinically insignificant disease. PATIENTS AND METHODS: Seventy-nine men (mean age 59.3 years, range 43-77) with a PSA level of <4. 0 ng/mL were identified from 702 who had a radical prostatectomy between 1994 and 2000. Demographic and clinical data were analysed; pathological specimens were evaluated by routine haematoxylin and eosin staining and immunohistochemistry with anti-PSA antibody, for both pathological staging and grading, and for the presence of PSA production. Tumours were classified as 'clinically insignificant' if the tumour volume was <0.5 ml and the Gleason score <7. RESULTS: The mean (SD, range) preoperative PSA level was 3.04 (0.85, 0.8-3.8) ng/mL. Indications for biopsy included an abnormal digital rectal examination (61%), a PSA velocity of >075 ng/mL/year (12%), a strong family history of prostate cancer (3%), obstructive urinary symptoms (2%), or no obvious indication (23%). Thirty-eight (48%) tumours were clinically insignificant. Of 41 clinically significant cancers, 13 had a final Gleason score of ≥7, 20 had extraprostatic extension and 11 had a tumour volume of ≥10 mL. Of the 79 prostate cancer specimens 78 stained strongly for PSA; the exception was a Gleason 9 tumour. With a mean (range) follow-up of 3.5 (0.18-6) years only one patient had a biochemical recurrence (PSA ≥0.1 ng/mL). CONCLUSIONS: Most prostate cancers in men with a PSA level of <4.0 ng/mL are clinically significant and PSA-producing. Many of these tumours are high-grade, high-volume and extraprostatic. We are currently exploring factors to explain why serum PSA is not elevated in these men, including tumour location, pattern of invasion and microvessel density.

Original languageEnglish (US)
Pages (from-to)499-502
Number of pages4
JournalBJU International
Issue number4
StatePublished - Mar 2004


  • Clinically significant
  • Immunohistochemistry
  • PSA
  • Prostate cancer
  • Prostatectomy

ASJC Scopus subject areas

  • Urology


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