(-2)proPSA and Prostate Health Index (PHI) in predicting the presence of prostate cancer in transrectal biopsies
Authors:
Kateřina Ryšánková 1; Vladimír Bartoš 2; Jan Krhut 1; Tereza Albínová 1; Kristián Šafarčík 2; Ondřej Havránek 1; Radoslava Tomanová 3
Authors‘ workplace:
Urologická klinika Fakultní nemocnice Ostrava
1; Ústav laboratorní diagnostiky Fakultní nemocnice Ostrava
2; Ústav patologie Fakultní nemocnice Ostrava
3
Published in:
Ces Urol 2018; 22(1): 40-47
Category:
Original Articles
Overview
Major statement:
The yield of Prostate Health index is significantly higher when compared to total PSA or Free PSA index
Purpose:
At present, new markers are introduced into clinical practice in the diagnosis of prostate cancer. The greatest attention is paid to the isoform of free fraction of prostate‑specific antigen (PSA) (-2)proPSA and the Prostate Health Index (PHI). The aim of this work is to evaluate the sensitivity of these new markers in the prediction of positive prostate biopsy and the capture of high risk prostate carcinomas compared to standard PSA.
Material and Methods:
Overall 129 patients with elevated prostate specific antigen PSA and / or positive DRE underwent transrectal ultrasound‑guided prostate biopsies. Prior to prostate biopsy, blood was drawn to measure total PSA, fPSA, and (-2)proPSA levels. From these values were calculated free PSA Index (FPSAI) and PHI. We compared the reliability of biomarkers, including their ability to identify high‑risk prostate cancer with a Gleason score 4 + 3 and higher.
Statistics:
Testing the significance of the difference between independent sets of negative and positive patients was performed by the nonparametric Mann‑Whitney’s sequential test. DeLong methodology was used to compare the significance of area differences under the curves (AUC) obtained by ROC analysis.
Results:
From 129 patients, prostate cancer was diagnosed in 60, 16 met the criteria for high‑risk carcinoma. Median PHI (63.0 vs. 33.9) did significantly differ between men with and without prostate cancer. Median PSA (7.27 vs. 5.42 μg/l) and FPSAI (FPSAI 12.9 vs. 16.0) did not differ between groups.
Conclusion:
The sensitivity and specificity of PHI in predicting the presence of prostate cancer in biopsy and the prediction of the occurrence of high risk carcinoma is significantly greater than that of PSA and FPSAI.
Key words:
Diagnose, PHI, prostate cancer.
Sources
1. Vyzula R, Adámková-Krákorová D, Arenberger P, a kol. Modrá kniha České onkologické společnosti, 22. aktualizace, 2016, Brno.
2. Fossati N, Buffi NM, Haese A, et al. Preoperative Prostate‑specific Antigen Isoform p2PSA and Its Derivatives, %p2PSA and Prostate Health Index, Predict Pathologic Outcomes in Patients Undergoing Radical Prostatectomy for Prostate Cancer: Results from a Multicentric European Prospective Study. Eur Urol. 2015; 68(1): 132–138.
3. Lazzeri M, Lughezzani G, Haese A, et al. Clinical performance of prostate health index in men with tPSA >10 ng/ml: Results from a multicentric European study. Urol Oncol: Seminars and Original Investigations 34 (2016) 415e13–415e19.
4. Thakur V, Singh PP, Talwar M, Mukherjee U. Utility of free/total prostate specific antigen (f/t PSA) ratio in diagnosis of prostate carcinoma. Dis Markers. 2003–2004; 19(6): 287–292.
5. Mikolajczyk SD, Catalona WJ, Evans CL, et al. Proenzyme forms of prostate‑specific antigen in serum improve the detection of prostate cancer. Clin Chem. 2004; 50(6): 1017–1025.
6. Catalona WJ, Partin AW, Sanda MG, et al. 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. 2011; 185(5): 1650–1655.
7. Mikolajczyk SD, Millar LS, Wang TJ, et al. A precursor form of prostate‑specific antigen is more highly elevated in prostate cancer compared with benign transition zone prostate tissue. Cancer Res. 2000; 60(3): 756–759.
8. Loeb S, Catalona WJ. The Prostate Health Index: a new test for the detection of prostate cancer. Ther Adv Urol. 2014; 6(2): 74–77.
9. Lazzeri M, Haese A, de la Taille A, et al. Serum isoform (-2)proPSA derivatives significantly improve prediction of prostate cancer at initial biopsy in a total PSA range of 2–10 ng/ml: a multicentric European study. Eur Urol. 2013; 63(6): 986–994.
10. Catalona WJ, Bartsch G, Rittenhouse HG, et al. Serum pro prostate specific antigen improves cancer detection compared to free and complexed prostate specific antigen in men with prostate specific antigen 2 to 4 ng/ml. J Urol. 2003; 170(6 Pt 1): 2181–2185.
11. Fossati N, Buffi NM, Haese A, el al. Preoperative Prostate‑specific Antigen Isoform p2PSA and Its Derivatives, %p2PSA and Prostate Health Index, Predict Pathologic Outcomes in Patients Undergoing Radical Prostatectomy for Prostate Cancer: Results from a Multicentric European Prospective Study. Eur Urol. 2015; 68(1): 132–138.
12. Guazzoni G, Lazzeri M, Nava L See comment in PubMed Commons belet al. Preoperative prostate‑specific antigen isoform p2PSA and its derivatives, %p2PSA and prostate health index, predict pathologic outcomes in patients undergoing radical prostatectomy for prostate cancer. Eur Urol. 2012;61(3):455–66
13. Porpiglia F, Cantiello F, De Luca S, et al. In‑parallel comparative evaluation between multiparametric magnetic resonance imaging, prostate cancer antigen 3 and the prostate health index in predicting pathologically confirmed significant prostate cancer in men eligible for active surveillance. BJU Int. 2016; 118(4): 527–534.
14. Tosoian J, Loeb S, Kettermann A, et al. Accuracy of PCA3 measurement in predicting short‑term biopsy progression in an active surveillance program. J Urol 2010; 183: 534–538.
15. Lughezzani G, Lazzeri M, Buffi NM, et al. Preoperative prostate health index is an independent predictor of early biochemical recurrence after radical prostatectomy: Results from a prospective single‑center study. Urol Oncol. 2015; 33(8): 337.e7–14.
16. Fuchsová R, Topolčan O, Klečka J, et al. Stanovení sérových markerů v diferenciální diagnostice časného karcinomu prostaty (pilotní studie). Klin. Biochem. Metab. 2013; 21(42): 19–22.
17. Fuchsova R, Topolcan O, Windrichova J, et al. PHI in the early detection of prostate cancer. Anticancer Res. 2015; 35(9): 4855–4857.
18. Nicholson A, Mahon J, Boland A, et al. The clinical effectiveness and cost‑effectiveness of the PROGENSA® prostate cancer antigen 3 assay and the Prostate Health Index in the diagnosis of prostate cancer: a systematic review and economic evaluation. Health Technol Assess. 2015; 19.87: 69–102, dostupné z https://www.ncbi.nlm.nih.gov/books/NBK321910/ doi: 10.3310/hta19870, přístup 21. 6. 2017.
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Czech Urology
2018 Issue 1
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