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Clinical Research

ProPSA and the Prostate Health Index as predictive markers for aggressiveness in low-risk prostate cancer—results from an international multicenter study

Prostate Cancer and Prostatic Diseases volume 20, pages 271–275 (2017)Cite this article

Subjects

Abstract

Background:

One of the major challenges in prostate cancer (PCa) treatment is distinguishing insignificant PCa from those forms that need active treatment. We evaluated the impact of PSA isoforms on risk stratification in patients with low-risk PCa as well as in active surveillance (AS) candidates who underwent radical prostatectomy.

Methods:

A total of 112 patients with biopsy confirmed Gleason score (GS) 6 PCa of four different international institutions were prospectively enrolled in the study. Blood withdrawal was performed the day before radical prostatectomy. In addition, patients were classified according to the EAU and NCCN criteria for AS candidates. PSA, free PSA (fPSA) and proPSA were measured using dual monoclonal antibody sandwich immunoassays. In addition, the Prostate Health Index (PHI=proPSA/fPSA × √PSA) was calculated. Final histology of the radical prostatectomy specimens was correlated to PSA, its isoforms and PHI.

Results:

Serum proPSA levels were significantly elevated in those patients with an upgrade in final histology (GS⩾7). In addition, higher proPSA levels were predictive for extraprostatic extension (⩾pT3a) as well as for positive surgical margins. Interestingly, PHI had an even higher predictive power when compared with proPSA alone concerning GS upgrading, extraprostatic extension and surgical margins in both the total and the AS patient group.

Conclusion:

We showed in a multicenter study that proPSA is a valuable biomarker to detect patients with aggressive PCa in a cohort of GS 6 patients, who would benefit from active tumor therapy. Combining proPSA with the standard markers PSA and fPSA using PHI further increases the predictive accuracy significantly. Moreover, our data support the use of PHI for monitoring PCa patients under AS.

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Acknowledgements

We thank Dr Gabriele Dobler for technical support. The study was funded by the Tiroler Krebshilfe (Grant to IH).

Author contributions

IH was involved in planning and organizing the study, ethics, sample collection in Innsbruck, funding, manuscript and preparation of the revised manuscript. RP was involved in sample collection and preparation in Innsbruck, manuscript. AP contributed towards the ethics, sample collection and preparation in Innsbruck, manuscript, preparation of the revised manuscript. WP was involved in the laboratory analyses. ES was involved in the statistics and preparation of the revised manuscript. AP, EC and CL were involved in the sample collection in Bolzano. AL and EP was involved in the sample collection in Vienna. DD was involved in the sample collection in Belgrad. WH, HK and JB contributed towards the general idea and supervision.

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Authors and Affiliations

  1. Department of Urology, Medical University Innsbruck, Innsbruck, Austria

    I Heidegger, H Klocker, R Pichler, E Steiner, W Horninger & J Bektic

  2. Department of Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria

    A Pircher

  3. Department of Laboratory and Chemical Medicine, Medical University Innsbruck, Innsbruck, Austria

    W Prokop

  4. Department of Urology, Hospital of Bolzano, Bolzano, Italy

    C Ladurner, E Comploj & A Pycha

  5. Department of Urology, Hanusch Hospital Wien, Vienna, Austria

    A Lunacek & E Plas

  6. Department of Urology, Klinicki centar Srbije Beograd, Belgrade, Serbia

    D Djordjevic

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Correspondence to J Bektic.

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Supplementary Information accompanies the paper on the Prostate Cancer and Prostatic Diseases website

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Heidegger, I., Klocker, H., Pichler, R. et al. ProPSA and the Prostate Health Index as predictive markers for aggressiveness in low-risk prostate cancer—results from an international multicenter study. Prostate Cancer Prostatic Dis 20, 271–275 (2017). https://doi.org/10.1038/pcan.2017.3

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