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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (2): 234-239. doi: 10.19723/j.issn.1671-167X.2020.02.007

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Clinical value of serum isoform [-2] proprostate-specific antigen and its derivatives in predicting aggressive prostate cancer

Kui-xia SUN,Cun-ling YAN(),Zhi-yan LI,Ping LIU,Wei ZHANG,Qun HE   

  1. Department of Clinical Laboratory, Peking University First Hospital, Beijing 100034, China
  • Received:2019-12-02 Online:2020-04-18 Published:2020-04-18
  • Contact: Cun-ling YAN E-mail:yancunling@163.com

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Abstract:

Objective: To explore the clinical value of serum isoform [-2] proprostate-specific antigen (p2PSA) and its derivatives %p2PSA and prostate health index (PHI) in predicting aggressive prostate cancer (PCa).Methods: The pre-operation serum and basic clinical data of 322 patients with PCa (including 143 patients diagnosed with PCa by transrectal ultrasound-guided prostate biopsy and 179 patients undergoing radical prostatectomy) in Peking University First Hospital were collected from August 2015 to May 2018. Serum total prostate-specific antigen (tPSA), free prostate antigen (fPSA) and fPSA/tPSA (f/t) and the p2PSA level of all these patients were measured on automatic immune analyzers DxI800, and then %p2PSA and PHI were calculated. The prostate pathologic result was considered as the gold standard to evaluate the Gleason score of the patients with PCa. Receiver operator curves (ROC) were used to assess the ability of p2PSA, %p2PSA and PHI to predict aggressive PCa (pathologic Gleason score≥7) compared with those traditional markers tPSA, fPSA and f/t.Results: Among these patients, the p2PSA, %p2PSA and PHI median levels were significantly higher in patients with pathologic Gleason score≥7 than those with Gleason score<7 (p2PSA: 30.22 ng/L vs. 18.33 ng/L; %p2PSA: 2.50 vs. 1.27; PHI:91.81 vs. 35.44;all P<0.01). The area under curve (AUC) of %p2PSA and PHI (0.770, 0.760) in predicting Gleason score≥7 were higher than those of the traditional indicators tPSA, fPSA and f/t (AUC were 0.648, 0.536 and 0.693, respectively). Among those patients diagnosed with PCa by transrectal ultrasound-guided prostate biopsy, the AUC of %p2PSA and PHI (AUC were 0.808 and 0.801, respectively) in predicting Gleason score≥7 were higher than those of the traditional indicators tPSA, fPSA and f/t (AUC were 0.729,0.655 and 0.665 respectively). Among those patients undergoing radical prostatectomy, PHI and %p2PSA also had the trend of higher predictive value than those of the traditional indicators. The AUC of %p2PSA and PHI were 0.798 and 0.744, respectively while the AUC of tPSA, fPSA and f/t were 0.625, 0.507 and 0.697, respectively.Conclusion: Compared with traditional markers tPSA, fPSA and f/t, %p2PSA and PHI had much higher predictive value for aggressive PCa, which may help clinicians to evaluate the therapeutic regime and make more appropriate management plan for the patients.

Key words: Isoform [-2] proprostate-specific antigen, Prostate health index, Prostate cancer

CLC Number: 

  • R737.2

Table 1

Basic data for PCa patients with different Gleason score"

Items Gleason score≥7(n=278) Gleason score<7(n=44) t/U P
Age/years, $\bar{x}±s$ 67.5±7.1 67.8±7.9 0.238 >0.05
tPSA /(μg/L), M(Min, Max) 13.35 (0.03, 699.5) 8.11 (0.67, 57.33) 2.950 <0.01
fPSA/(μg/L), M(Min, Max) 1.29 (0.01, 47.84) 1.06 (0.26, 6.10) 0.714 >0.05
f/t, M(Min, Max) 0.10 (0.03, 0.67) 0.17(0.04, 0.42) 3.824 <0.01
p2PSA/(ng/L), M(Min, Max) 30.22 (0.25, 10254.36) 18.33 (3.94, 197.42) 3.516 <0.01
%p2PSA, M(Min, Max) 2.50 (0.08, 24.32) 1.27 (0.34, 6.04) 5.346 <0.01
PHI, M(Min, Max) 91.81 (0.01, 3037.97) 35.44 (8.95, 332.87) 5.038 <0.01

Table 2

Value of each index for predicting PCa patients (in total) with Gleason score≥7"

Items Cut-off value AUC 95%CI Sensitivity/% Specificity/%
tPSA/(μg/L) 9.76 0.648 0.592 - 0.701 63.8 67.6
fPSA/(μg/L) 1.25 0.536 0.476 - 0.589 50.3 58.9
f/t 0.16 0.693 0.639 - 0.744 73.1 51.4
p2PSA/(ng/L) 29.39 0.673 0.618 - 0.725 67.2 72.9
%p2PSA 1.68 0.770 0.719 - 0.815 83.3 74.9
PHI 64.00 0.760 0.709 - 0.806 81.1 78.4

Figure 1

ROC curves for each index to predict PCa patients (in total) with Gleason score≥7 tPSA, total prostate-specific antigen; fPSA, free prostate-specific antigen; f/t, fPSA/tPSA; p2PSA, isoform [-2] proprostate-specific antigen; %p2PSA, p2PSA/(fPSA×1 000)×100; PHI, prostate health index."

Table 3

Value of each index for predicting PCa patients (identified by biopsy) with Gleason score≥7"

Items Cut-off value AUC 95%CI Sensitivity/% Specificity/%
tPSA/ (μg/L) 9.76 0.729 0.647 - 0.801 76.8 66.7
fPSA/ (μg/L) 3.27 0.655 0.570 - 0.734 50.7 72.6
f/t 0.13 0.665 0.580 - 0.743 67.6 66.7
p2PSA/ (ng/L) 35.60 0.751 0.670 - 0.820 77.7 75.2
%p2PSA 1.87 0.808 0.732 - 0.870 80.5 74.1
PHI 54.90 0.801 0.725 - 0.864 80.2 77.8

Figure 2

ROC curves for each index to predict PCa patients (identified by biopsy) with Gleason score≥7 tPSA, total prostate-specific antigen;fPSA, free prostate-specific antigen; f/t, fPSA/tPSA; p2PSA, isoform [-2] proprostate-specific antigen; %p2PSA, p2PSA/(fPSA×1 000)×100; PHI, prostate health index."

Table 4

Value of each index for predicting PCa patients (received radical prostatectomy) with Gleason score≥7"

Items Cut-off value AUC 95%CI Sensitivity/% Specificity/%
tPSA/(μg/L) 8.51 0.625 0.549 - 0.696 61.7 70.0
fPSA/(μg/L) 0.95 0.507 0.431- 0.583 63.3 60.1
f/t 0.20 0.697 0.623 - 0.763 74.0 50.0
p2PSA/(ng/L) 23.95 0.710 0.637- 0.776 77.3 70.4
%p2PSA 1.52 0.744 0.673 - 0.806 84.6 69.7
PHI 35.44 0.798 0.731- 0.855 82.8 70.8

Figure 3

ROC curves for each index to predict PCa patients (received radical prostatectomy) with Gleason score≥7 tPSA, total prostate-specific antigen; fPSA, free prostate-specific antigen; f/t, fPSA/tPSA; p2PSA, isoform [-2] proprostate- specific antigen; %p2PSA, p2PSA/(fPSA×1 000)×100; PHI, prostate health index."

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