Association of Serum Prostate-Specific Antigen Levels with Gleason Grade Groups in Prostatic Adenocarcinoma

Abstract

Background: Prostatic adenocarcinoma is a common malignancy in elderly men. Serum prostate-specific antigen (PSA) is widely used in the clinical evaluation of prostatic disease, while Gleason grading and International Society of Urological Pathology (ISUP) Grade Groups provide histological assessment of tumour aggressiveness. Correlating serum PSA with Grade Group may aid clinicopathological risk stratification. Objective: To evaluate the association between pre-treatment serum PSA levels and Gleason Grade Groups in patients aged more than 70 years with histologically confirmed prostatic adenocarcinoma. Materials and Methods: A hospital-based observational cross-sectional study was conducted at Mata Chanan Devi Hospital, Janakpuri, New Delhi, over three months from January to March 2026. Sixty consecutive histologically confirmed cases of acinar adenocarcinoma of the prostate in patients aged >70 years were included. Clinical symptoms, pre-treatment serum total PSA, Gleason score and ISUP Grade Group were recorded. Differences in PSA across Grade Groups were assessed and Spearman rank correlation was used to evaluate the relationship between PSA and Grade Group. Results: The mean age was 76.9 ± 4.2 years (range 71–89 years). Increased urinary frequency was the commonest symptom (81.7%), followed by nocturia (76.7%), urgency (68.3%), poor urinary stream (61.7%), hesitancy (55.0%) and dysuria (46.7%). Grade Groups 1–5 comprised 7 (11.7%), 11 (18.3%), 14 (23.3%), 15 (25.0%) and 13 (21.7%) cases, respectively. Median PSA increased progressively from 10.6 ng/mL in Grade Group 1 to 79.2 ng/mL in Grade Group 5. Serum PSA showed a strong positive correlation with increasing Grade Group (Spearman rho=0.66, p<0.001). Conclusion: Serum PSA levels increased significantly with increasing Gleason Grade Group. Markedly elevated PSA values were concentrated in Grade Groups 4 and 5. PSA is useful as a complementary marker but should be interpreted with histopathological grade rather than used independently.

Keywords: Prostatic adenocarcinoma; prostate-specific antigen; PSA; Gleason score; ISUP Grade Group; histopathology; prostate cancer.