JPSIM Journal of Pakistan Society of Internal Medicine J Pak Soc Intern Med 2709-8729 2710-0804 Pakistan Society of Internal Medicine 10.70302/jpsim.v7i1.2613 jpsim.v7i1.2613 Original Research Diagnostic Accuracy of Serum Prostate Specific Antigen (PSA ≥50ng/ml)in Estimating Aggressiveness of Adenocarcinoma of Prostate (Gleason Score ≥7) Niamat Uzma Riaz Sarah histopathologist2015@gmail.com * Jaleel Shahila Niazi Farah Bano Akhtar Mavra Histopathology Department Sheikh Zaid Al Nahyan Hospital, Lahore *Correspondence: Sarah Riaz (histopathologist2015@gmail.com) 10 03 2026 2026 7 1 62 67 27 11 2025 14 01 2026 18 02 2026 Copyright © 2026 The Author(s) 2026 The Author(s) https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective

To assess the diagnostic accuracy of serum PSA > or = 50ng/ml in estimating aggressiveness of adenocarcinoma of prostate (Gleason score 7 or more).

 Background

An alternative to the Gleason score (GS), a new grading system for the diagnosis of prostate cancer was applied in this study based on the modified Gleason score grouping which included five Grade groups. The main objective of our study was to evaluate the diagnostic accuracy of PSA level ≥50 ng/ml for evaluation of the aggressiveness of adenocarcinoma prostate (GS ≥7) in patients with this tumor.

 Methodology

This descriptive, cross-sectional study was done at the Histopathology department of Shaikh Zayed Hospital, Lahore, from October 2024 to April 2025. Formalin fixed samples of 338 patients aged 40-70yrs with suspected prostate cancer were done. Pre-biopsy PSA levels were selected through non-probability, consecutive sampling. Eight needle core TRUS biopsies of each patient, received in separate containers fixed in formalin and submitted in separate blocks, were studied after Hematoxylin and Eosin staining. The Gleason score (GS) was calculated. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PSA ≥50 ng/ml were used to calculate the aggressiveness of adenocarcinoma of prostate (GS ≥7). Demographic information was noted on predesigned proforma.

 Results

Patients (Mean age=56.43+7.90 years) had a mean duration of 10.36+10.51 months for prostate cancer. Gleason score ≥7 was found in 99 (29.29%) and

 Conclusion

The serum total PSA was found strongly correlated with tumor diagnosis and tumor aggressiveness. The sensitivity and specificity of serum PSA levels was 65.7% sensitive and 82.8% specific at a cut off value of 50 ng/ml. for diagnosing aggressiveness

 Keywords Prostate Specific antigen Carcinoma Gleason's score Ethics Statement

Ethics committee: Institutional Review Board / Ethics Committee (IRB/EC). Approval number: 2125/IRB/PINS/Approval/2025, dated April 15, 2025.

 References Höti N, Joshi M, Acharya KK. Urinary PSA and serum PSA for aggressive prostate cancer detection. Cancer (Basel). 2023;15(8):2256. Ngowi BN, Mremi A, Seif MJ, Kyara YS, Mteta VK, Bright F, et al. Prostate cancer: burden and correlation with prostate specific antigen among screened African men in Tanzania. Res Rep Urol. 2024;10.2147/RRU.S472472. Merriel SWD, Funston G, Hamilton W. Prostate-specific antigen testing for prostate cancer: a systematic review and meta-analysis. Br J Gen Pract. 2022;72(718): e389–97. Akkaya H, Yılmaz Ö, Bozkurt MF, Taş ZA, Öztürk İS, Gülek B. Can the Gleason score be predicted in patients with prostate cancer? DCE-MRI, 68Ga-PSMA PET/CT, PSA and PSA-density comparison study. Diag Interven Radiol. 2023;27(5):647. Yaxley W, Delahunt B, Yaxley J, Thunders MC, Kenwright DN, Egevad L, et al. Prognostic significance of percentage Gleason grade 5 prostatic adenocarcinoma in needle biopsies from patients treated by radical prostatectomy. Pathology. 2022;54(6):694–9. Russo GI, Soeterik T, Puche-Sanz I, Broggi G, Lo Giudice A, De Nunzio C, et al. European Association of Urology Young Academic Urologists. Oncological outcomes of cribriform histology pattern in prostate cancer patients: a systematic review and meta-analysis. Prostate Cancer Prost Dis. 2023;26(4):646-54. Destouni M, Lazaris AC, Tzelepi V. Cribriform patterned lesions in the prostate gland with emphasis on differential diagnosis and clinical significance. Cancers. 2022;14(13):3041. Zelic R, Giunchi F, Fridfeldt J, Carlsson J, Davidsson S, Lianas L, et al. Prognostic utility of the gleason grading system revisions and histopathological factors beyond gleason grade. Clin Epidemiol. 2022;4(1):59-70. Samaratunga H, Egevad L, Yaxley J, Perry-Keene J, Le Fevre I, Kench J, et al. Gleason score 3+ 3= 6 prostatic adenocarcinoma is not benign, and the current debate is unhelpful to clinicians and patients. Pathology. 2024;56(1):33-8. Montironi R, Cheng L, Cimadamore A, Mazzucchelli R, Scarpelli M, Santoni M, et al. Narrative review of prostate cancer grading systems: will the Gleason scores be replaced by the Grade Groups? Translat Androl Urol. 2021;10(3):1530. Pirlamarla AK, Hansen CC, Deng M, Handorf E, Paly J, Wong JK, et al. Early prostate-specific antigen kinetics for low-and intermediate-risk prostate cancer treated with definitive radiation therapy. Pract Radiat Oncol. 2022;12(1):60-7. Dave P, Carlsson SV, Watts K. Randomized trials of PSA screening. InUrologic Oncology: Seminars and Original Investigations. Elsevier. 2025;43(1):23-8). Okpua NC, Okekpa SI, Njaka S, Emeh AN. Clinical diagnosis of prostate cancer using digital rectal examination and prostate-specific antigen tests: a systematic review and meta-analysis of sensitivity and specificity. Af J Urol. 2021;27(1):32. Jin Y, Jung JH, Han WK, Hwang EC, Nho Y, Lee N, et al. Diagnostic accuracy of prostate-specific antigen below 4 ng/mL as a cutoff for diagnosing prostate cancer in a hospital setting: A systematic review and meta-analysis. Invest Clin Urol. 2022;63(3):251. Van Poppel H, Albreht T, Basu P, Hogenhout R, Collen S, Roobol M. Serum PSA-based early detection of prostate cancer in Europe and globally: past, present and future. Nat Rev Urol. 2022;19(9):562-72. Lumbreras B, Fernández-de-Loma M, Monteagudo M. Variables associated with false-positive prostate-specific antigen (PSA) results: a systematic review. Cancer. 2022;14(1):261. Goktas O. Prostate Cancer Screening with Prostate-Specific Antigen (PSA) Testing: A Retrospective Study. Pak J Med Sci. 2024;40(10):2324-30. Martin RM, Turner EL, Young GJ, Metcalfe C, Walsh EI, Lane JA, et al. Prostate-specific antigen screening and 15-year prostate cancer mortality: a secondary analysis of the CAP randomized clinical trial. JAMA. 2024;331(17):1460-70. Lin K, Lipsitz R, Miller T, Janakiraman S. Benefits and harms of prostate-specific antigen screening for prostate cancer: an evidence update for the US Preventive Services Task Force. Ann Intern Med. 2008;149(3):192-9. Kim SH, Kim HJ, Choi YD, Lee WK, Lee SW, Choi HS. Correlation and diagnostic performance of the prostate-specific antigen level with the diagnosis, aggressiveness, and bone metastasis of prostate cancer in clinical practice. Prostate Int. 2014;2(2):71–77.