You have accessJournal of UrologyProstate Cancer: Markers II1 Apr 20122227 SERUM ISOFORM [−2]PROPSA (P2PSA) AND ITS DERIVATES, %P2PSA AND PHI (PROSTATE HEALTH INDEX), ARE MORE ACCURATE OF REFERENCE STANDARD TEST (PSA) IN MEN SCHEDULED FOR REPEAT BIOPSY Massimo Lazzeri, Giovanni Lughezzani, Vincenzo Scattoni, Vittorio Bini, Alessandro Larcher, Andrea Cestari, Giulio Maria Gadda, Tommaso Maga, Patrizio Rigatti, Francesco Montorsi, and Giorgio Guazzoni Massimo LazzeriMassimo Lazzeri Milan, Italy More articles by this author , Giovanni LughezzaniGiovanni Lughezzani Milan, Italy More articles by this author , Vincenzo ScattoniVincenzo Scattoni Milan, Italy More articles by this author , Vittorio BiniVittorio Bini Perugia, Italy More articles by this author , Alessandro LarcherAlessandro Larcher Milan, Italy More articles by this author , Andrea CestariAndrea Cestari Milan, Italy More articles by this author , Giulio Maria GaddaGiulio Maria Gadda Milan, Italy More articles by this author , Tommaso MagaTommaso Maga Milan, Italy More articles by this author , Patrizio RigattiPatrizio Rigatti Milan, Italy More articles by this author , Francesco MontorsiFrancesco Montorsi Milan, Italy More articles by this author , and Giorgio GuazzoniGiorgio Guazzoni Milan, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2403AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study is to determine the performance characteristics and clinical utility of the isoform [−2]proPSA and its derivates in detecting PCa in men scheduled for repeat biopsy. METHODS This study was an observational prospective evaluation of a cohort of men with one or two previous negative prostate biopsies, with persistent suspicion of PCa (suspected DRE, elevated tPSA and or low f/tPSA) who were scheduled for repeat biopsy. Men receiving medical therapy known to affect serum PSA (dutasteride and finasteride), suffering from prostatitis and having had invasive treatment for benign prostatic hyperplasia (BPH), were excluded. Serum p2PSA, and it derivates, namely %p2PSA {([−2]proPSA/10)/fPSA)} and Beckman Coulter phi (prostate health index) {[[−2]proPSA/fPSA] x squart PSA} were considered the index tests and compared with the standard referenced test (tPSA, fPSA and f/tPSA). All the patients underwent ambulatory repeated TRUS-guided 18 core prostate biopsies. The primary outcome was to evaluate the accuracy of p2PSA and its derivates in detecting PCa at repeat biopsy. RESULTS From June 2010 and June 2011, 222 men underwent repeated biopsy. PCa cancer was found in 71/222 (31.9%) subjects. p2PSA, %p2PSA and phi values were significantly higher (p<0.0001), and %fPSA values significantly lower (p<0.0001) in patients with PCa. At univariate accuracy analysis, %p2PSA (AUC: 72.5%) and phi (AUC: 67.2%) were the most accurate predictors and significantly outperformed tPSA (AUC: 51.8%). %p2PSA significantly outperformed %fPSA (AUC: 60.2%) in the prediction of PCa (p≤0.001), but not PHI (p=0.136). At 90% of sensitivity, the cut-off of %p2PSA and PHI were respectively of 1.23 and 28.8 with a specificity of 40.4 and 25.2%. At a %p2PSA cut-off of 1.23 a total of 153 (68.9%) biopsies could be avoided; an overall of 6 PCa patients would have been missed but only 1 (5%) patient with a Gleason score of 7 or greater would have been missed. At a PHI cut-off of 28.8 a total of 116 (52.25%) biopsies could be avoided; an overall of 6 PCa patients would have been missed but no patients with a Gleason score of 7 or greater would have been missed. CONCLUSIONS %p2PSA and PHI are more accurate than standard reference tests (tPSA, fPSA and f/tPSA) in predicting repeat prostate biopsy outcome and may be indicative of cancer aggressiveness. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e898 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Massimo Lazzeri Milan, Italy More articles by this author Giovanni Lughezzani Milan, Italy More articles by this author Vincenzo Scattoni Milan, Italy More articles by this author Vittorio Bini Perugia, Italy More articles by this author Alessandro Larcher Milan, Italy More articles by this author Andrea Cestari Milan, Italy More articles by this author Giulio Maria Gadda Milan, Italy More articles by this author Tommaso Maga Milan, Italy More articles by this author Patrizio Rigatti Milan, Italy More articles by this author Francesco Montorsi Milan, Italy More articles by this author Giorgio Guazzoni Milan, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...