Department of Urology, Ospedale San Raffaele Turro, San Raffaele Scientific Institute, Milan, Italy.
Department of Urology, Ospedale San Raffaele Turro, San Raffaele Scientific Institute, Milan, Italy.
Urology. 2014 Mar;83(3):606-12. doi: 10.1016/j.urology.2013.10.016. Epub 2013 Dec 6.
To investigate the relationship between serum [-2]proPSA (p2PSA) and derivatives with chronic histologic prostatic inflammation (CHPI) in men undergoing prostate biopsy for suspected prostate cancer (PCa).
This nested case-control study resulted from an observational prospective trial for the definition of sensibility, specificity, and accuracy of p2PSA, %p2PSA, and Beckman Coulter Prostate Health Index (PHI), in men undergoing prostate biopsy, with a total prostate-specific antigen (PSA) of 4-10 ng/mL and normal digital rectal examination. CHPI was the outcome of interest and defined as the presence of moderate to large infiltration of lymphomononuclear cells with interstitial and/or glandular disruption in absence of PCa. p2PSA, %p2PSA, and PHI were considered the index tests and compared with the established biomarker reference standard tests: tPSA, fPSA, %fPSA.
Of 267 patients subjected to prostate biopsy, 73 (27.3%) patients were diagnosed with CHPI. Comparing CHPI with PCa patients, %p2PSA and PHI were found to be significantly lower, whereas fPSA and %fPSA were significantly higher. %p2PSA and PHI were the most accurate predictors of CHPI at biopsy, significantly outperforming tPSA, fPSA, and %fPSA. On the contrary, no significant differences were found in PSA, p2PSA, and derivatives between CHPI and benign prostatic hyperplasia (BPH) patients.
Our findings showed that p2PSA, %p2PSA, and PHI values might discriminate PCa from CHPI or BPH, but not CHPI from BPH, in men with a total PSA 4-10 ng/mL and normal digital rectal examination. p2PSA isoform and its derivatives could be useful in clinical decision making to avoid unnecessary biopsies in patients with CHPI and elevated tPSA value.
研究血清 [-2] 前列腺特异性抗原（p2PSA）及其衍生物与接受前列腺癌（PCa）疑似前列腺活检的男性慢性组织学前列腺炎症（CHPI）之间的关系。
本巢式病例对照研究源自一项观察性前瞻性试验，用于定义 p2PSA、%p2PSA 和贝克曼库尔特前列腺健康指数（PHI）在总前列腺特异性抗原（PSA）为 4-10ng/ml 且数字直肠检查正常的男性前列腺活检中的敏感性、特异性和准确性，CHPI 是感兴趣的结果，定义为在没有 PCa 的情况下存在中等至大量的淋巴单核细胞浸润，伴有间质和/或腺体破坏。p2PSA、%p2PSA 和 PHI 被视为指标试验，并与已建立的生物标志物参考标准试验进行比较：tPSA、fPSA、%fPSA。
在 267 名接受前列腺活检的患者中，73 名（27.3%）患者被诊断为 CHPI。与 CHPI 与 PCa 患者相比，%p2PSA 和 PHI 显著降低，而 fPSA 和 %fPSA 显著升高。%p2PSA 和 PHI 是活检中 CHPI 的最准确预测指标，显著优于 tPSA、fPSA 和 %fPSA。相反，在 CHPI 和良性前列腺增生（BPH）患者之间，PSA、p2PSA 和衍生物之间没有发现显著差异。
我们的研究结果表明，在总 PSA 为 4-10ng/ml 且数字直肠检查正常的男性中，p2PSA、%p2PSA 和 PHI 值可能有助于区分 PCa 与 CHPI 或 BPH，但不能区分 CHPI 与 BPH。p2PSA 同工型及其衍生物可用于临床决策，以避免 CHPI 伴 tPSA 升高患者的不必要活检。
