Abstract
This prospective study sought to clarify the developmental endothelial locus-1 (Del-1) protein as values of diagnosis and risk stratification of prostate cancer (PCa). From February 2017 to December 2019, a total 458 patients who underwent transrectal ultrasound guided prostate biopsy or surgery of benign prostatic hyperplasia agreed to research of Del-1 protein. We prospectively compared and analyzed the Del-1 protein and prostate specific antigen (PSA) in relation to the patients' demographic and clinicopathological characteristics. Mean age was 68.86±8.55 years. Mean PSA and Del-1 protein was 21.72±89.37, 0.099±0.145, respectively. Two hundred seventy-six (60.3%) patients were diagnosed as PCa. Among them, 181 patients underwent radical prostatectomy (RP). There were significant differences in Del-1 protein between benign and PCa group (0.066±0.131 vs 0.121±0.149, respectively, p<0.001). When we set the cut-off value of del-1 protein as 0.120, in patients with 3≤PSA≤8, positive predictive value and specificity of Del-1 protein (≥0.120) for predicting PCa were 88.9% (56/63) and 93.5% (101/108), respectively. Among 181 patients who underwent RP, there were significant differences in Del-1 protein according to stage (pT2 vs pT3a vs ≥pT3b) (0.113±0.078, 0.171±0.121, 0.227±0.161, respectively, p<0.001) and to Gleason score (6 (3+3) or 7 (3+4) vs 7 (4+3) or 8 (4+4) vs 9 or 10) (0.134±0.103, 0.150±0.109, 0.212±0.178, respectively, P = 0.044). Multivariate analysis showed that PSA, Del-1 protein and high Gleason score (≥9) were the independent prognostic factors for predicting higher pT stage (≥3b). Furthermore, age, PSA and Del-1 protein were independent prognostic factors for predicting significant PCa. Patients with PCa showed higher expression of Del-1 protein than benign patients. Del-1 protein increased with the stage and Gleason score of PCa. Collaboration with PSA, Del-1 protein can be a non-invasive useful marker for diagnosis and risk stratification of PCa.
Highlights
Serum prostate-specific antigen (PSA) is the most widely used biomarker for the early detection and management of prostate cancer (PCa)
developmental endothelial locus-1 (Del-1) protein increased with the stage and Gleason score of PCa
Current PSA screening is not cost-effective from a public health perspective [3] and many urologists are concerning for over-diagnosis of PCa with widespread serum PSA screening, which eventually could lead to overtreatment of PCa and its accompanied morbidities
Summary
Serum prostate-specific antigen (PSA) is the most widely used biomarker for the early detection and management of PCa. The diagnosis of prostate cancer (PCa) is precipitated by a persistent increase in the serum PSA level, which triggers the performance of a prostate biopsy. PSA screening is controversial due to its relative lack of cancer specificity. Some study has shown that only 32.4% of patients with a PSA 4.0 ng/mL or higher had PCa [2]. Prostate biopsy under transrectal ultrasound (TRUS) is the only tool for diagnosing PCa, but it is invasive and can cause side effects such as infection and gross hematuria, and can give considerable discomfort to the patients during procedure
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