Investig Clin Urol.  2020 Jan;61(1):42-50. 10.4111/icu.2020.61.1.42.

Preoperative prostate health index and %p2PSA as the significant biomarkers of postoperative pathological outcomes of prostate cancer in Korean males: A prospective multi-institutional study

• Park H
• Lee SW
• Song G
• Kang TW
• Jung JH
• Chung HC
• Kim SJ
• Park JY
• Shin TY
• Kim JH

• KMID: 2466791
• DOI: http://doi.org/10.4111/icu.2020.61.1.42

Abstract

PURPOSE
To evaluate the clinical utility of percentage of serum prostate-specific antigen (proPSA) to free PSA (%p2PSA) and the prostate health index (PHI) for predicting aggressive pathological outcomes of radical prostatectomy (RP) in Korean males.
MATERIALS AND METHODS
This prospective observational multicenter study included 160 Korean males who consecutively underwent RP. The predictive utility of preoperative %p2PSA and PHI for predicting the following pathological outcomes of RP including pT3 disease, pathologic Gleason sum ≥7, and Gleason sum upgrading was investigated using multivariate and decision-curve analyses.
RESULTS
The PHI and %p2PSA levels were significantly higher in patients with pT3 disease, pathologic Gleason sum ≥7, and Gleason sum upgrading. On univariate analysis, PHI was an accurate predictor of pT3 disease, pathologic Gleason sum ≥7, and Gleason sum upgrading. Multivariate and decision curve analyses revealed that inclusion of PHI to a base multivariate model including total PSA, percentage free PSA, PSA density, percentage of positive biopsy core, biopsy Gleason sum, and clinical stage factors significantly increased its predictive accuracy; %p2PSA showed a similar result. However, PHI was a more valuable predictor of pathological outcomes of RP.
CONCLUSIONS
This study revealed PHI and %p2PSA as preoperative biomarkers of pathological outcomes in Korean males who underwent RP for prostate cancer.

Keyword

Pathology; Prostatectomy; Prostatic neoplasms

MeSH Terms

Biomarkers*
Biopsy
Humans
Male*
Pathology
Prospective Studies*
Prostate*
Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms*
Biomarkers
Prostate-Specific Antigen

Figure

• 

  Fig. 1 Percentage of p2PSA to free PSA (%p2PSA) and prostate health index (PHI) relative to tumor stage, Gleason sum (GS), and GS upgrading. PSA, prostate specific antigen; p2PSA, [−2]proPSA; %p2PSA, percentage of p2PSA to total PSA.

• 

  Fig. 2 Receiver operating characteristic curve predicting the probability of (A) T3 at pathologic staging, (B) Gleason sum (GS) ≥7 at pathologic grading, and (C) GS upgrading. PSA, prostate specific antigen; fPSA, free PSA; p2PSA, [−2]proPSA; %p2PSA, percentage of p2PSA to tPSA; PHI, prostate health index.

• 

  Fig. 3 Decision curve analysis of the effect of the prediction models. The net benefit is plotted against various threshold probabilities. (A) Detection of pT3 at radical prostatectomy. T-stage model 1 is a basic model that includes clinical stage, percentage of positive biopsy core, total prostate-specific antigen (tPSA), free PSA (fPSA), percent fPSA (%fPSA), biopsy Gleason sum (GS), and PSA density. T-stage model 2 is a basic model that includes all factors of model 1 plus a percentage of p2PSA to fPSA (%p2PSA). T stage model 3 is a basic model, which includes all factors of model 1 plus the Prostate Health Index (PHI). (B) Detection of pathologic GS ≥7 at radical prostatectomy. GS model 1 is a basic model that includes clinical stage, percentage of positive biopsy core, tPSA, and %fPSA. GS Model 2 is a basic model that includes all of the factors of model 1 plus %p2PSA. GS model 3 is a basic model that includes all of the factors of model 1 plus the PHI. (C) Detection of the presence of GS upgrading at radical prostatectomy. Upgrading model 1 is a basic model that includes clinical stage, percentage of positive biopsy core, tPSA, and %fPSA. Upgrading model 2 is a basic model that includes all of the factors of model 1 plus %p2PSA. Upgrading model 3 is a basic model that includes all of the factors of model 1 plus the PHI.

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