Abstract
Systemic inflammation and immune responses are reported to be associated with progressive prostate cancer. In this study, we explored which among the fractions of white blood cell (WBC) and C-reactive protein (CRP) level were associated with high Gleason score prostate cancer. Prostate needle biopsy was performed in 966 men with suspicion of prostate cancer. We assessed age, serum prostate-specific antigen (PSA), prostate volume, WBC count, fractions of WBCs (neutrophils, lymphocytes, monocytes, basophils, and eosinophils), and CRP level before biopsy for associations with biopsy findings. Among all men, 553 (57.2%) were positive for prostate cancer including 421 with high Gleason score cancer (Gleason score ≥7). Age, PSA, PSA density (PSAD), serum monocyte fraction of WBC, monocyte-to-lymphocyte ratio (MLR), and CRP were significantly associated with high Gleason score cancer (p<0.01). Multivariate analysis showed that age, PSA, PSAD, and serum monocyte fraction were significantly associated with high Gleason score prostate cancer (p <0.01). In 571 patients with PSA of <10 ng/ml, age, PSA, PSAD, serum WBC count, neutrophil fraction, monocyte fraction, and MLR were significantly associated with high Gleason score prostate cancer (p<0.05). Multivariate analysis showed that age, PSAD, and serum monocyte fraction were significantly associated with high Gleason score prostate cancer (p<0.01). The monocyte fraction of WBCs was increased in patients with high Gleason score prostate cancer, suggesting an interaction of monocytes with the progression of prostate cancer.
Highlights
Serum prostate-specific antigen (PSA) level has been widely used to detect prostate cancer and monitor its treatment, including surgical therapy, radiotherapy, hormonal therapy, chemotherapy, and active surveillance
We explored which among the fractions of white blood cell (WBC) and C-reactive protein (CRP) level were associated with high Gleason score prostate cancer
Multivariate analysis showed that age, PSA, PSA density (PSAD), and serum monocyte fraction were significantly associated with high Gleason score prostate cancer (p
Summary
Serum prostate-specific antigen (PSA) level has been widely used to detect prostate cancer and monitor its treatment, including surgical therapy, radiotherapy, hormonal therapy, chemotherapy, and active surveillance. Several serum or urine biomarkers for higher sensitivity and specificity of detection of prostate cancer have emerged, [2, 3] the problem of overdiagnosis and overtreatment of clinically insignificant prostate cancer remains unresolved. To formulate an appropriate differential diagnosis between clinically significant and insignificant prostate cancer, we need convenient biomarkers for the prediction of pathological high Gleason score cancer (Gleason score of ≥7) before needle biopsy. We reported that urinary fucosylated PSA is one of the new biomarkers for the detection of high Gleason score cancer. We reported that low serum neutrophil count predicts a positive prostate biopsy [5] and that the white blood cell (WBC) count is associated with benign prostatic hyperplasia.
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