Adverse Pathological Outcomes in Radical Prostatectomy Specimens in Patients with a Serum Prostate-specific Antigen Level ≤3 ng/mL

Objective: To evaluate clinicopathological features of patients with serum prostate-specific antigen (PSA) level of <= 3 ng/mL and diagnosed with prostate cancer (PCa).Materials and Methods: A total of 34 male patients diagnosed with PCa by either prostate needle biopsy (PNB) or transurethral resection of the prostate (TUR-P) were included in this study between January 2010 and June 2021. Patients whose preoperative serum PSA level was >3 ng/mL and those with missing clinical data were excluded. Preoperative clinical characteristics of the patients and pathological findings of PNB, TUR-P, and radical prostatectomy (RP) specimens were evaluated.Results: The median age of the patients was 65 (60-69) years. The median preoperative serum PSA level was 1.98 (1.45-2.64) ng/mL. PCa was detected by "systematic prostate biopsy (SBx) only", combined prostate biopsy [SBx following multiparametric magnetic resonance imaging-targeted prostate biopsy (TBx)], and "TUR-P" in 6 (17.6%), 17 (50.0%), and 11 (32.4%) patients, respectively. In combination of both biopsy, PCa was detected in "SBx specimens only", "TBx specimens only", and "both TBx and SBx specimens" in 3 (8.8%), 5 (14.7%), and 9 (26.5%) patients, respectively. Clinically significant (cs) PCa was in 52.9% of the TBx (9/17) and 60.9% of the SBx (14/23) specimen. Twenty (58.8%) patients treated with RP. csPCa in RP specimens was observed in 17/20 (85.0%) patients. Upgrading in RP specimens compared with PNB specimens was observed in 5/11 (45.5%) of the TBx and 9/17 (52.9%) of the SBx specimen. At the final RP pathology, International Society of Urologic Pathology-grade group >3 or non-organ confined disease were observed in 8 (40%) and 8 (40.0%) patients, respectively.Conclusions: Adverse pathological outcomes in RP specimens are frequent in patients with PCa with a serum PSA level of <= 3 ng/mL at the time of diagnosis, and physicians should be aware of the limitations of pre-set PSA cut-off levels.