A pilot study evaluating serum pro-prostate-specific antigen in patients with rising PSA following radical prostatectomy

Antonino Sottile, Cinzia Ortega, Alfredo Berruti, Monica Mangioni, Sara Saponaro, Alessandra Polo, Veronica Prati, Giovanni Muto, Massimo Aglietta, Filippo Montemurro

Research output: Contribution to journalArticlepeer-review


[-2]pro-prostate-specific antigen (2pPSA), a proform of PSA, is a new marker in patients at risk of prostate cancer. We explored the potential role of 2pPSA in the identification of patients with metastatic progression following radical prostatectomy for prostate cancer. Seventy-six patients with biochemical (PSA) recurrence following radical prostatectomy were studied retrospectively. Diagnostic imaging performed at the time of biochemical recurrence confirmed metastatic disease in 31 of the 76 patients. Serum samples were collected and stored at the time of imaging-confirmed metastatic progression or at the most recent procedure for patients with negative imaging. Median values of PSA, free PSA (fPSA), %fPSA, 2pPSA and prostate health index (PHI) were compared between metastatic and non-metastatic patients by the Mann-Whitney U test. The results of each test were then correlated with metastatic status by univariate and multivariate logistic regression analysis. PSA, fPSA, %fPSA, 2pPSA serum concentrations and PHI values were statistically significantly higher in patients with metastatic disease. Results of the multivariate analysis revealed that 2pPSA remained a statistically significant predictor of imaging-proven metastatic prostate cancer among patients with biochemical recurrence. At a cut-off value of 12.25 pg/ml, 2pPSA outperformed the other markers in terms of sensitivity and specificity (97 and 80%, respectively) with respect to imaging-confirmed metastatic progression. This is the first study suggesting that 2pPSA predicts diagnostic imaging-proven metastatic disease in previously resected prostate cancer patients with biochemical recurrence. Our results merit validation in a prospective study.

Original languageEnglish
Pages (from-to)819-824
Number of pages6
JournalOncology Letters
Issue number4
Publication statusPublished - Apr 2012


  • [-2]pro-prostate-specific antigen
  • Biochemical recurrence
  • Cancer metastasis
  • Prostate cancer

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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