The Four-Kallikrein Panel is Effective in Identifying Aggressive Prostate Cancer in a Multiethnic Population.

The four-kallikrein (4K) panel has been demonstrated to improve prediction of aggressive prostate cancer (PCa) compared to prostate-specific antigen (PSA) among men with moderately elevated PSA levels. However, the development and testing of the 4K panel has been conducted primarily in White men, with limited data in African Americans and no studies in other racial and ethnic groups.

We evaluated the 4K panel in a nested case-control study among African American, Latino, Japanese, Native Hawaiian, and White men in the Multiethnic Cohort (MEC). Pre-diagnostic blood levels of free, intact, and total PSA and human kallikrein-related peptidase 2 were measured among 1,667 incident PCa cases and 691 controls with PSA≥2 ng/mL. We evaluated the discriminative ability of the 4K panel within and across all racial/ethnic groups.

The 4K panel enhanced discrimination of overall PCa compared to free plus total PSA and total PSA alone (AUC 0.748 versus 0.711 and 0.669, respectively). Discrimination was further enhanced for Gleason 8+ PCa, aggressive PCa, and death due to PCa, and to a lesser degree for non-aggressive PCa. Improvement of the 4K panel over PSA was observed in each population. Adding a PCa polygenic risk score slightly improved upon the discriminative ability of the 4K panel.

The superior discriminative ability of the 4K panel over PSA for overall and aggressive PCa across multiethnic populations indicates the broad clinical applicability of the 4K panel.

Our multiethnic investigation suggests potential for the 4K panel to improve current PCa screening practices.

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2020 May 08 [Epub ahead of print]

Burcu F Darst, Alisha Chou, Peggy Wan, Loreall Pooler, Xin Sheng, Emily A Vertosick, David V Conti, Lynne R Wilkens, Loic Le Marchand, Andrew J Vickers, Hans G Lilja, Christopher A Haiman

Center for Genetic Epidemiology, Department of Preventive Medicine, University of Southern California ., Center for Genetic Epidemiology, Department of Preventive Medicine, University of Southern California., Preventive Medicine, University of Southern California., Keck School of Medicine, USC., Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center., Department of Preventive Medicine, Keck School of Medicine, University of Southern California., Department of Epidemiology, University of Hawaii Cancer Center., Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center., Department of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center., Department of Preventive Medicine, University of Southern California.