Relationship of Chronic Histologic Prostatic Inflammation in Biopsy Specimens With Serum Isoform [-2]proPSA (p2PSA), %p2PSA, and Prostate Health Index in Men With a Total Prostate-specific Antigen of 4-10 ng/mL and Normal Digital Rectal Examination

• Published in: Urology (Ridgewood, N.J.) N.J.), 2014-03, Vol.83 (3), p.606-612
• Main Authors: Lazzeri, Massimo, Abrate, Alberto, Lughezzani, Giovanni, Gadda, Giulio Maria, Freschi, Massimo, Mistretta, Francesco, Lista, Giuliana, Fossati, Nicola, Larcher, Alessandro, Kinzikeeva, Ella, Buffi, Nicolòmaria, Dell'Acqua, Vincenzo, Bini, Vittorio, Montorsi, Francesco, Guazzoni, Giorgio
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Chronic Disease; Digital Rectal Examination; Humans; Male; Middle Aged; Prospective Studies; Prostate-Specific Antigen - blood; Prostatic Hyperplasia - blood; Prostatic Hyperplasia - pathology; Prostatic Neoplasms - blood; Prostatic Neoplasms - pathology; Prostatitis - blood; Prostatitis - pathology; Protein Precursors - blood; Sensitivity and Specificity; Severity of Illness Index; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2013.10.016

Objective To investigate the relationship between serum [−2]proPSA (p2PSA) and derivatives with chronic histologic prostatic inflammation (CHPI) in men undergoing prostate biopsy for suspected prostate cancer (PCa). Methods This nested case-control study resulted from an observational prospective trial for the definition of sensibility, specificity, and accuracy of p2PSA, %p2PSA, and Beckman Coulter Prostate Health Index (PHI), in men undergoing prostate biopsy, with a total prostate-specific antigen (PSA) of 4-10 ng/mL and normal digital rectal examination. CHPI was the outcome of interest and defined as the presence of moderate to large infiltration of lymphomononuclear cells with interstitial and/or glandular disruption in absence of PCa. p2PSA, %p2PSA, and PHI were considered the index tests and compared with the established biomarker reference standard tests: tPSA, fPSA, %fPSA. Results Of 267 patients subjected to prostate biopsy, 73 (27.3%) patients were diagnosed with CHPI. Comparing CHPI with PCa patients, %p2PSA and PHI were found to be significantly lower, whereas fPSA and %fPSA were significantly higher. %p2PSA and PHI were the most accurate predictors of CHPI at biopsy, significantly outperforming tPSA, fPSA, and %fPSA. On the contrary, no significant differences were found in PSA, p2PSA, and derivatives between CHPI and benign prostatic hyperplasia (BPH) patients. Conclusion Our findings showed that p2PSA, %p2PSA, and PHI values might discriminate PCa from CHPI or BPH, but not CHPI from BPH, in men with a total PSA 4-10 ng/mL and normal digital rectal examination. p2PSA isoform and its derivatives could be useful in clinical decision making to avoid unnecessary biopsies in patients with CHPI and elevated tPSA value.