Abstract
Simple SummaryPTX3 could be a potential biomarker for PCa. To predict anyPCa and csPCa biomarker PTX3 was evaluated before PBx. Among the 455 eligible patients, PCa was detected in 49% and csPCa in 25%. PTX3 outperformed other variables in predicting both anyPCa and csPCa. Serum PTX3 levels might be of clinical utility in predicting prostate biopsy results.Purpose: To test and internally validate serum Pentraxin-3 (PTX3) levels as a potential PCa biomarker to predict prostate biopsy (PBx) results. Materials and Methods: Serum PSA and serum PTX3 were prospectively assessed in patients scheduled for PBx at our Institution due to increased serum PSA levels or abnormal digital rectal examination. Uni- and multivariable logistic regression analysis, area under the receiver operating characteristic curve (AUC), and decision curve analysis (DCA), were used to test the accuracy of serum PTX3 in predicting anyPCa and clinically significant PCa (csPCa) defined as Gleason Grade (GG) ≥ 2. Results: Among the 455 eligible patients, PCa was detected in 49% and csPCa in 25%. During univariate analysis, PTX3 outperformed other variables in predicting both anyPCa and csPCa. The addition of PTX3 to multivariable models based on standard clinical variables, significantly increased each model’s predictive accuracy for anyPCa (AUC from 0.73 to 0.82; p < 0.001) and csPCa (AUC from 0.79 to 0.83; p < 0.001). At DCA, PTX3, and PTX3, density showed higher net benefit than PSA and PSA density and increased the net benefit of multivariable models in deciding when to perform PBx. Conclusions: Serum PTX3 levels might be of clinical utility in predicting prostate biopsy results. Should our findings be confirmed, this novel reflex test could be used to reduce the number and burden of unnecessary prostate biopsies.
Highlights
The gold standard for the diagnosis of prostate cancer (PCa) is prostate biopsy (PBx), but the diagnostic yield of this procedure remains low
Efforts to improve the diagnostic yield of PBx are oriented towards the use of risk calculators based on several clinical parameters, imaging techniques, prostate multiparametric magnetic resonance imaging, and serum or urine-based biomarkers
The present study was carried out onto consecutive patients scheduled for transrectal ultrasound (TRUS) guided PBx at our institution, between January 2016 and December 2017, due to increased serum prostatespecific antigen (PSA) levels (≥3 ng/mL) or abnormal digital rectal examination (DRE)
Summary
The gold standard for the diagnosis of prostate cancer (PCa) is prostate biopsy (PBx), but the diagnostic yield of this procedure remains low. The cancer detection rate (CDR) of a first extended PBx prompted by an elevated serum prostatespecific antigen (PSA) level or an abnormal digital rectal examination (DRE), is in the range of 40% and drops down to approximately 25% in the setting of screening programs, i.e., in patients with serum PSA between 2.5 and 10 ng/mL [1,2] Even though it is a routine outpatient procedure, PBx is not free from complications that might even be severe [3]. Up to 2019, EAU guidelines [4] provided a strong recommendation to offer asymptomatic men with normal DRE and serum PSA level < 10 ng/mL further assessment tools, such as a risk calculator, a prostate mp-MRI, and an additional serum or urine biomarker. The 2020 EAU Guidelines [5] provide, in such clinical situations, a strong recommendation for risk calculators and imaging, but a weak recommendation for additional biomarkers, probably due to the fact that none of those discovered in the recent years proved to perform so well to enter clinical practice
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