Abstract
The aim of this study was to assess the relationship between pre-prostatectomy urinary Engrailed-2 (EN2), a transcription factor secreted by prostate cancer cells, with tumour volume and pathological characteristics in resected prostate specimens. First pass urine samples (10 ml) without prior prostatic massage were collected and stored at –80°C. EN2 levels were measured using an enzyme-linked immunoabsorbent assay. Tumour volume in the prostatectomy specimens was determined histologically. 57 men undergoing RP in one urological cancer network were evaluated. EN2 was detected in 85% of RP patients. EN2 correlated with tumour volume (but not total prostatic volume) in a linear regression analysis, with increasing pathological T stage and margin positivity. Using three “cutoff levels” of tumour volume (0.5 ml, 1.3 ml and 2.5 ml) to define “significant disease”, men with “significant disease” had markedly higher levels of urinary EN2 (p Levels of urinary EN2 may be useful in predicting tumour volume in men with prostate cancer by potentially identifying men with small volume “insignificant” disease. This study justifies a larger multicentre evaluation of urinary EN2 levels as a biomarker of PC significance using cancer volume, pathological and PSA criteria.
Highlights
For over 20 years, prostate specific antigen (PSA) testing has provided the opportunity for the detection of prostate cancer (PC) at an earlier and, more likely curative stage of the disease
The aim of this study was to assess the relationship between pre-prostatectomy urinary Engrailed-2 (EN2), a transcription factor secreted by prostate cancer cells, with tumour volume and pathological characteristics in resected prostate specimens
We reported the potential diagnostic utility of Engrailed-2 (EN2), a transcription factor involved in embryonic brain development that is re-expressed in PC [6]
Summary
For over 20 years, prostate specific antigen (PSA) testing has provided the opportunity for the detection of prostate cancer (PC) at an earlier and, more likely curative stage of the disease. PSA has been (and remains) a valuable cancer biomarker, the limited sensitivity and specificity of PSA for cancer at the age-specific cut-offs [1,2] and its elevation in benign prostate disorders continues to limit its utility. There is no consistent correlation between PSA and the grade, stage or volume of disease [3]. There is an urgent need for novel biomarkers which aid clinical decision making with respect to biopsy and primary therapy [5]. The presence of EN2 in urine was predictive of PC, with a sensitivity of 66% and a specificity of 88.2% (AUC of 0.81). We further demonstrated a strong positive correlation between pre-surgical levels of urinary EN2 and tumour volume in RP specimens in a retrospective series, as well as a correlation between EN2 levels and tumour stage (T2 vs. T3) [7]
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