Preoperative %p2PSA and Prostate Health Index Predict Pathological Outcomes in Patients with Prostate Cancer Undergoing Radical Prostatectomy

Yung-Ting Cheng,Jian-Hua Hong,Hong-Chiang Chang,Yi-Kai Chang,Yuan-Ju Lee,Shih-Ping Liu,Kuo-How Huang,I-Ni Chiang,Chung-Hsin Chen,Yeong-Shiau Pu,Yu-Chuan Lu,Po-Ming Chow,Chih-Hung Chiang,Shih-Ting Chiu,Shih-Chun Hung,Chao-Yuan Huang

doi:10.1038/s41598-020-57618-2

Abstract

To evaluate the predictive accuracy of the %p2PSA and prostate health index (PHI) in predicting aggressive pathological outcomes in patients with prostate cancer (PCa) undergoing radical prostatectomy (RP), we enrolled 91 patients with organ-confined PCa who were treated with robot-assisted RP. p2PSA levels and the PHI were investigated for their ability to predict pathological results. The %p2PSA and PHI were both significantly higher in patients with ≥pT3 disease, high-risk disease, positive surgical margin, or seminal vesical invasion (SVI). In univariable analysis, p2PSA derivatives were significant predictors of the presence of ≥pT3 disease, high-risk disease, positive surgical margin, and SVI. To predict adverse pathological outcomes at a sensitivity of 90%, p2PSA derivatives had higher specificity than standard PSA derivatives. In multivariable analysis, additional increases in the area under the receiver operating characteristic curve (AUC) were observed with the %p2PSA and PHI for ≥pT3 disease, high-risk disease, and positive surgical margin (8.2% and 2.7%, 6.2% and 4.1%, and 8.6% and 5.4%, respectively). A PHI ≥61.26 enhanced the predictive accuracy of the model for SVI by increasing the AUC from 0.624 to 0.819 (p = 0.009). The preoperative %p2PSA and PHI accurately predict adverse pathological results and are useful for decision-making.

Highlights

Multiple preoperative predictive nomograms have been validated for the prediction of pathological outcomes at RP
The utility of magnetic resonance imaging (MRI) in local cancer staging is limited by its poor sensitivity for detecting extracapsular extension and seminal vesical invasion (SVI)[6]
We confirmed the accuracy of the preoperative %p2PSA and prostate health index (PHI) in predicting adverse pathological results for patients with clinically organ-confined PCa undergoing RP

Summary

Introduction

Multiple preoperative predictive nomograms have been validated for the prediction of pathological outcomes at RP. The utility of MRI in local cancer staging is limited by its poor sensitivity for detecting extracapsular extension and seminal vesical invasion (SVI)[6]. Adverse pathological characteristics and determining who might benefit the most from surgery Such a biomarker would help physicians in decision-making and to predict prognosis before any intervention. The %p2PSA and PHI are able to identify aggressive PCa with GS ≥7 prior to TRUSP biopsy and predict unfavorable cancer characteristics at the final pathology from RP11,12. A lack of a reference range of the %p2PSA and PHI for predicting adverse pathological results limits their clinical utility. We aimed to validate the application of the preoperative %p2PSA and PHI to predict adverse pathological outcomes after RP and examine the accuracy of the cut-off values

Objectives

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Conclusion