Original Research

Diagnostic Accuracy of Serum Prostate Specific Antigen (PSA ≥50ng/ml)in Estimating Aggressiveness of Adenocarcinoma of Prostate (GleasonScore ≥7)

Uzma Niamat
Histopathology Department Sheikh Zaid Al Nahyan Hospital, Lahore
Sarah Riaz
Histopathology Department Sheikh Zaid Al Nahyan Hospital, Lahore
Shahila Jaleel
Histopathology Department Sheikh Zaid Al Nahyan Hospital, Lahore
Farah Bano Niazi
Histopathology Department Sheikh Zaid Al Nahyan Hospital, Lahore
Mavra Akhtar
Histopathology Department Sheikh Zaid Al Nahyan Hospital, Lahore

✉ Correspondence: Sarah Riaz Email: histopathologist2015@gmail.com

DOI https://doi.org/10.70302/jpsim.v7i1.2613
Volume: 7, Issue 1 Pages: 62–67 Published: 10 Mar 2026
Received: 27 Nov 2025 Revised: 14 Jan 2026 Accepted: 18 Feb 2026 Published Online: 10 Mar 2026

Abstract

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.

Methods

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 <7 in 239 (70.71%) patients. Serum PSA levels <50 ng/ml were found in 232 (68.64%) and ≥50 ng/ml in 106 (31.36%). On histopathology, PSA levels ≥50 ng/ml were 65.7% sensitive and 82.8% specific in diagnosing aggressiveness of adenocarcinoma. PSA levels Positive predictive value (PPV) was 61.3% and negative predictive value (NPV) was 85.3%.
Age stratification of two age groups 40-55 and 56-70 years showed sensitivity of PSA as 68.9% and 63.0% respectively, whereas the specificity as 80.2%. and 85.4% respectively. Duration stratification showed prostate cancer <6 months, sensitivity of PSA levels was 77.1%, and specificity was 82.2%.

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

How to Cite This Article

Niamat U, Riaz S, Jaleel S, Niazi FB, Akhtar M. Diagnostic Accuracy of Serum Prostate Specific Antigen (PSA ≥50ng/ml)in Estimating Aggressiveness of Adenocarcinoma of Prostate (GleasonScore ≥7). J Pak Soc Intern Med. 2026;7(1):62–67. doi:10.70302/jpsim.v7i1.2613

Conflict of Interest

All authors declare no competing interests.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

No specific funding was received for this research.

Funder information follows the Crossref Funder Registry standard.

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CC BY CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2026 Journal of Pakistan Society of Internal Medicine.
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