Urinary Biomarker Panel to Improve Accuracy in Predicting Prostate Biopsy Result in Chinese Men with PSA 4-10 ng/mL.

Yongqiang Zhou,Minjun Jiang,Yun Li,Xiangnan Li

doi:10.1155/2017/2512536

Abstract

This study aims to evaluate the effectiveness and clinical performance of a panel of urinary biomarkers to diagnose prostate cancer (PCa) in Chinese men with PSA levels between 4 and 10 ng/mL. A total of 122 patients with PSA levels between 4 and 10 ng/mL who underwent consecutive prostate biopsy at three hospitals in China were recruited. First-catch urine samples were collected after an attentive prostate massage. Urinary mRNA levels were measured by quantitative real-time polymerase chain reaction (qRT-PCR). The predictive accuracy of these biomarkers and prediction models was assessed by the area under the curve (AUC) of the receiver-operating characteristic (ROC) curve. The diagnostic accuracy of PCA3, PSGR, and MALAT-1 was superior to that of PSA. PCA3 performed best, with an AUC of 0.734 (95% CI: 0.641, 0.828) followed by MALAT-1 with an AUC of 0.727 (95% CI: 0.625, 0.829) and PSGR with an AUC of 0.666 (95% CI: 0.575, 0.749). The diagnostic panel with age, prostate volume, % fPSA, PCA3 score, PSGR score, and MALAT-1 score yielded an AUC of 0.857 (95% CI: 0.780, 0.933). At a threshold probability of 20%, 47.2% of unnecessary biopsies may be avoided whereas only 6.2% of PCa cases may be missed. This urinary panel may improve the current diagnostic modality in Chinese men with PSA levels between 4 and 10 ng/mL.

Highlights

The diagnosis of prostate cancer (PCa) has mostly relied on prostate-specific antigen (PSA) levels and digital rectal examinations (DRE) in the past decades [1]
The prostate cancer antigen 3 (PCA3) score and PSGR score were higher in high-grade PCa compared with low-grade PCa (116.8 versus 60.0, P = 0.005, and 186.5 versus 111.9, P = 0.009, resp.), but the prostate-specific membrane antigen (PSMA) score was similar in high-grade and low-grade PCa (P = 0.672)
To the best of our knowledge, this is the first study investigating the diagnostic performance of PCA3, PSGR, metastasis-associated lung adenocarcinoma transcript 1 (MALAT-1), and PSMA in an Asian population

Summary

Introduction

The diagnosis of prostate cancer (PCa) has mostly relied on prostate-specific antigen (PSA) levels and digital rectal examinations (DRE) in the past decades [1]. Recent studies in Japanese [4] and Chinese populations [5] have validated that it is effective in Asian populations, these studies showed a relatively lower AUC than some Western studies. Other urinary biomarkers such as metastasis-associated lung adenocarcinoma transcript 1 (MALAT-1), prostate-specific G protein coupled receptor (PSGR), and prostate-specific membrane antigen (PSMA) were confirmed to be associated with PCa as well. Urinary MALAT-1 was associated with the risk of prostate cancer in Chinese populations and may serve as a better biomarker with a higher specificity and AUC than PSA [6]. Previous studies showed that urinary PSMA could be detected and that it was a potential biomarker for the diagnosis of prostate cancer [9]

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Conclusion