EAU 2018: Urinary Steroidal Profile as Innovative and Not Expensive Tool in Differential Diagnosis Between Benign Prostate Hyperplasia and Prostate Carcinoma

Copenhagen, Denmark (UroToday.com)  The relationship between benign prostate hyperplasia (BPH)/prostate carcinoma (PCa) and hormonal profile is well documented. PCa and BPH have often similar elevated PSA (for the range of 4-10 ng/mg) and no specific symptoms. Even though novel blood and urine biomarker tests are available, they are not routinely used due to the lack of clinical validated data. In the present study the authors evaluated the utility of a urinary steroidal profile (USP) in BPH and PCa diagnosis.

The USP evaluated during this study provides the dosage of 23 androgenic markers (18 androgens, testosterone, dihydrotestosterone and the principal phase I metabolites, plus 5 specific urinary steroidal ratios). This panel of exams are routinely evaluated in sportive doping control. The K-PLS (Kernel partial least square) regression approach over the USP of 242 subjects (20-80 yrs age range) and the R2 equal to 0.75 confirms the hypothesis of age as bias factor in the evaluation of the USP.  The authors focused on men aged 60-80 yrs, in which prostatic diseases are more common. In this age range, the regression coefficient fell to 0.16, and this was used as an unbiased reference age range. 

A cohort of 113 patients affected by BPH (PSA values ≤ 4ng/mL or PSA > 4 ng/mL with negative biopsy), and 93 subjects with histologically proved PCa were enrolled. Subsequently, a USP model based on the PLS discriminant analysis (PLS-DA) was performed to distinguish between benign and malignant prostatic disease.

The results demonstrated that the AUC (area under curve) of the ROC (Receiver Operating Characteristic) curve for the line distinguishing between BPH and PCa was 0.93. Furthermore, sensitivity and specificity were 9% and 94%, respectively.

In conclusion, the USP classification model showed a significant discrimination between BPH and PCa in the 60-80 yrs age range. Further studies are necessary to evaluate the performance of this innovative and cheap diagnostic tool.


Presented by: Porpiglia F., San Luigi Gonzaga Hospital, Dept. of Urology, Orbassano, Italy

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, twitter: @GoldbergHanan at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark