The Prostate Health Index in predicting initial prostate biopsy outcomes in Asian men with prostate-specific antigen levels of 4–10 ng/mL
- 434 Downloads
To investigate the role of the Prostate Health Index (phi) in prostate cancer (PCa) detection in patients with a prostate-specific antigen (PSA) level of 4–10 ng/mL receiving their first prostatic biopsy in an Asian population.
This was a retrospective study of archived serum samples from patients enlisted in our tissue bank. Patients over 50 years old, with PSA level of 4–10 ng/mL, a negative digital rectal examination, and received their first prostatic biopsy between April 2008 and April 2013, were recruited. The serum sample collected before biopsy was retrieved for the measurement of various PSA derivatives and the phi value was calculated for each patient. The performance of these parameters in predicting the prostatic biopsy results was assessed.
Two hundred and thirty consecutive patients, with 21 (9.13 %) diagnosed with PCa, were recruited for this study. Statistically significant differences between PCa patients and non-PCa patients were found for total PSA, PSA density, [-2]proPSA (p2PSA), free-to-total PSA ratio (%fPSA), p2PSA-to-free PSA ratio (%p2PSA), and phi. The areas under the curve of the receiver operating characteristic curve for total PSA, PSA density, %fPSA, %p2PSA, and phi were 0.547, 0.634, 0.654, 0.768, and 0.781, respectively. The phi was the best predictor of the prostatic biopsies results. At a sensitivity of 90 %, the use of the phi could have avoided unnecessary biopsies in 104 (45.2 %) patients.
Use of the phi could improve the accuracy of PCa detection in patients with an elevated PSA level and thus avoid unnecessary prostatic biopsies.
KeywordsProstate cancer Biomarkers Screening Prostate-specific antigen PSA density PSA isoform
The instruments and testing reagents for the study were provided free of charge by Beckman Coulter, with no restriction on the study results or their presentation.
Conflict of interest
- 4.Wagenlehner FM, van Oostrum E, Tenke P, Tandogdu Z, Cek M, Grabe M, Wullt B, Pickard R, Naber KG, Pilatz A, Weidner W, Bjerklund-Johansen TE, On behalf of the GPIU investigators (2013) Infective complications after prostate biopsy: outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and 2011, a prospective multinational multicentre prostate biopsy study. Eur Urol 63:521–527PubMedCrossRefGoogle Scholar
- 6.Jansen FH, van Schaik RH, Kurstjens J, Horninger W, Klocker H, Bektic J, Wildhagen MF, Roobol MJ, Bangma CH, Bartsch G (2010) Prostate-specific antigen (PSA) isoform p2PSA in combination with total PSA and free PSA improves diagnostic accuracy in prostate cancer detection. Eur Urol 57:921–927PubMedCrossRefGoogle Scholar
- 7.Guazzoni G, Nava L, Lazzeri M, Scattoni V, Lughezzani G, Maccagnano C, Dorigatti F, Ceriotti F, Pontillo M, Bini V, Freschi M, Montorsi F, Rigatti P (2011) Prostate-specific antigen (PSA) isoform p2PSA significantly improves the prediction of prostate cancer at initial extended prostate biopsies in patients with total PSA between 2.0 and 10.0 ng/ml: results of a prospective study in a clinical setting. Eur Urol 60:214–222PubMedCrossRefGoogle Scholar
- 8.Catalona WJ, Partin AW, Sanda MG, Wei JT, Klee GG, Bangma CH, Slawin KM, Marks LS, Loeb S, Broyles DL, Shin SS, Cruz AB, Chan DW, Sokoll LJ, Roberts WL, van Schaik RH, Mizrahi IA (2011) A multicenter study of [-2]pro-prostate specific antigen combined with prostate specific antigen and free prostate specific antigen for prostate cancer detection in the 2.0 to 10.0 ng/ml prostate specific antigen range. J Urol 185:1650–1655PubMedCentralPubMedCrossRefGoogle Scholar
- 16.Sokoll LJ, Ellis W, Lange P, Noteboom J, Elliott DJ, Deras IL, Blase A, Koo S, Sarno M, Rittenhouse H, Groskopf J, Vessella RL (2008) A multicenter evaluation of the PCA3 molecular urine test: pre-analytical effects, analytical performance, and diagnostic accuracy. Clin Chim Acta 389:1–6PubMedCrossRefGoogle Scholar
- 17.Roobol MJ, Schröder FH, van Leeuwen P, Hessels D, van den Bergh RC, Wolters T, van Leeuwen PJ (2010) Performance of the prostate cancer antigen 3 (PCA3) gene and prostate-specific antigen in prescreened men: exploring the value of PCA3 for a first-line diagnostic test. Eur Urol 58:893–899PubMedCrossRefGoogle Scholar
- 18.Semjonow A, Köpke T, Eltze E, Pepping-Schefers B, Burgel H, Darte C (2010) Pre-analytical in vitro stability of [-2]proPSA in blood and serum. Clin Chem 43:926–928Google Scholar