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Multicenter Study
, 33 (11), e94

Diagnostic Performance of %[-2]proPSA and Prostate Health Index for Prostate Cancer: Prospective, Multi-institutional Study

Multicenter Study

Diagnostic Performance of %[-2]proPSA and Prostate Health Index for Prostate Cancer: Prospective, Multi-institutional Study

Hongzoo Park et al. J Korean Med Sci.


Background: We evaluated the clinical performance of [-2]proPSA (p2PSA) and its derivatives in predicting the presence and aggressiveness of prostate cancer (PCa) in Korean men.

Methods: A total of 246 men with total prostate-specific antigen (tPSA) ≥ 3.5 ng/mL who underwent their first prostate biopsy were included in this prospective, multicenter, observational study. Diagnostic accuracy of tPSA, free-to-total PSA ratio (%fPSA), p2PSA, %p2PSA, and the Beckman Coulter prostate health index (PHI) was assessed by receiver operating characteristic curve analyses and logistic regression analyses.

Results: Overall, PCa was detected in 125 (50.8%) subjects. In men with tPSA 3.5-10 ng/mL, the detection rate of PCa was 39.4% (61/155). In this group, PHI and %p2PSA were the most accurate predictors of PCa and significantly outperformed tPSA and %fPSA; area under the curve for tPSA, %fPSA, %p2PSA, and PHI was 0.56, 0.69, 0.74, and 0.76, respectively. PHI was also the strongest predictor of PCa with Gleason score ≥ 7.

Conclusion: This study demonstrates the superior clinical performance of %p2PSA and PHI in predicting the presence and aggressiveness of PCa in Korean men. The %p2PSA and PHI appear to improve detection of PCa and provide prognostic information.

Keywords: Biomarkers; Biopsy; Early Diagnosis; Prostate-specific Antigen; Prostatic Cancer.

Conflict of interest statement

The authors have no potential conflicts of interest to disclose.


Fig. 1
Fig. 1
ROC curves of the prediction accuracy of PSA, %fPSA, %p2PSA, and PHI for prostate cancer at initial biopsy. (A) ROC curves in all subjects. (B) ROC curves in subjects with tPSA 3.5–10 ng/mL. ROC = receiver operating characteristic, PSA = prostate-specific antigen, fPSA = free PSA, p2PSA = [-2]proPSA, PHI = prostate health index, tPSA = total PSA.
Fig. 2
Fig. 2
Proportion of prostate cancer with GS ≥ 7 in relation to %p2PSA intervals (A) and PHI intervals (B). GS = Gleason score, PSA = prostate-specific antigen, p2PSA = [-2]proPSA, PHI = prostate health index.

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