Preoperative prostate-specific antigen isoform p2PSA and its derivatives, %p2PSA and prostate health index, predict pathologic outcomes in patients undergoing radical prostatectomy for prostate cancer: Results from a multicentric european prospective study

Nicola Fossati, Nicolò Maria Buffi, Alexander Haese, Carsten Stephan, Alessandro Larcher, Thomas McNicholas, Alexandre De La Taille, Massimo Freschi, Giovanni Lughezzani, Alberto Abrate, Vittorio Bini, Joan Palou Redorta, Markus Graefen, Giorgio Guazzoni, Massimo Lazzeri

Research output: Contribution to journalArticle

Abstract

Background: Currently available predictive models fail to assist clinical decision making in prostate cancer (PCa) patients who are potential candidates for radical prostatectomy (RP). New biomarkers would be welcome. Objective: To test the hypothesis that prostate-specific antigen (PSA) isoform p2PSA and its derivatives, percentage of p2PSA to free PSA (%p2PSA) and the Prostate Health Index (PHI), predict PCa characteristics at final pathology. Design, setting, and participants: An observational prospective multicentre European study was performed in 489 consecutive PCa patients treated with RP. Total PSA (tPSA), free PSA (fPSA), and p2PSA levels were determined. The %fPSA [(fPSA / tPSA) × 100], %p2PSA [(p2PSA pg/ml) / (fPSA ng/ml × 1000) × 100], and PHI [(p2PSA / fPSA) × HtPSA] were calculated. Intervention: Open or robot-assisted RP. Outcome measurements and statistical analysis: Logistic regression models were fitted to test the predictors of pT3 stage and/or pathologic Gleason score (GS) ≤7 and to determine their predictive accuracy. The base multivariable model included tPSA, digital rectal examination, biopsy GS, and percentage of positive biopsy cores. Decision curve analysis provided an estimate of the net benefit obtained using p2PSA, %p2PSA, or PHI. Results and limitations: Overall, 344 patients (70%) were affected by pT3 disease or pathologic GS ≤7; pT3 disease and pathologic GS ≤7 were present in 126 patients (26%). At univariable analysis, p2PSA, %p2PSA, and PHI were significant predictors of pT3 disease and/or pathologic GS ≤7 (all p 0.001). The inclusion of PHI significantly increased the accuracy of the base multivariable model by 2.3% ( p = 0.003) and 2.4% ( p = 0.01) for the prediction of pT3 disease and/or pathologic GS ≤7, respectively. However, at decision curve analysis, models including PHI did not show evidence of a greater clinical net benefit. Conclusions: Both %p2PSA and PHI are significant predictors of unfavourable PCa characteristics at final pathology; however, %p2PSA and PHI did not provide a greater net benefit for clinical decision making. Patient summary: Prostate-specific antigen (PSA) isoform p2PSA and its derivatives, percentage of p2PSA to free PSA and the Prostate Health Index, are associated with adverse characteristics of prostate cancer; however, these biomarkers provided only a slight net benefit for clinical decision making.

Original languageEnglish
Pages (from-to)132-138
Number of pages7
JournalEuropean Urology
Volume68
Issue number1
DOIs
Publication statusPublished - 2015

Keywords

  • Biomarkers
  • p2PSA
  • Pathologic outcomes
  • Predictive models
  • Prostate cancer
  • Prostate Health Index

ASJC Scopus subject areas

  • Urology

Fingerprint Dive into the research topics of 'Preoperative prostate-specific antigen isoform p2PSA and its derivatives, %p2PSA and prostate health index, predict pathologic outcomes in patients undergoing radical prostatectomy for prostate cancer: Results from a multicentric european prospective study'. Together they form a unique fingerprint.

  • Cite this