OBJECTIVES: To test the hypothesis that [-2]proPSA (p2PSA) and its derivates are more accurate than total-PSA (tPSA), free-PSA (fPSA) and percentage of fPSA to tPSA (%fPSA) in detecting prostate cancer (PCa) in men younger than 60 years.
SUBJECTS / PATIENTS AND METHODS: The analysis consisted of a nested case-control study from the PRO-psa Multicentric European Study (PROMEtheuS) project. The primary outcome was the measure of sensibility, specificity and accuracy of serum p2PSA, percentage of p2PSA to fPSA (%p2PSA) and Beckman Coulter PHI (Prostate Health Index) in men younger than 60 years of age who had undergone prostatic biopsy. The potential reduction of unnecessary biopsies and the characteristics of missing PCa were reported as secondary outcomes. Multivariate logistic regression models were complemented by predictive accuracy analysis and decision curve analysis.
RESULTS: Over 1036 patients enrolled, 238 (22.9%) were younger than 60 years of age. Prostate cancer was found in 67 subjects (28.1%). p2PSA, %p2PSA and PHI values were significantly higher (p< 0.0001) among these subjects; no differences were found for tPSA, fPSA and %fPSA values. At univariate analysis, %p2PSA (AUC: 0.704) and PHI (AUC: 0.7) were the most accurate predictors and significantly outperformed tPSA (AUC: 0.549), fPSA (AUC: 0.511) and %fPSA (AUC: 0.557) in the prediction of PCa at biopsy (p≤ 0.001). In multivariate logistic regression models, %p2PSA and PHI achieved independent predictor status and significantly increased the accuracy of multivariate models by 6.3% and 7.6%, respectively (p ≤ 0.05).
CONCLUSION: PHI and %p2PSA are more accurate than the reference standard tests in predicting PCa in young men.
Fossati N, Lazzeri M, Haese A, McNicholas T, de la Taille A, Buffi NM, Lughezzani G, Gadda GM, Lista G, Larcher A, Abrate A, Mistretta F, Bini V, Redorta JP, Graefen M, Guazzoni G. Are you the author?
Department of Urology, San Raffaele Turro, Vita-Salute San Raffaele University, Milan, Italy.
Reference: BJU Int. 2014 Mar 3. Epub ahead of print.