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Urinary PSA and Serum PSA for Aggressive Prostate Cancer Detection
Naseruddin Höti1,2, Tung-Shing Lih1, Mingming Dong1
1Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Cancers
|February 11, 2023
Summary
Urinary prostate-specific antigen (PSA) levels may help detect aggressive prostate cancer better than serum PSA. Combining urine and serum PSA tests improves diagnostic accuracy for aggressive disease.
Area of Science:
- Urology
- Oncology
- Biomarker Discovery
Background:
- Serum prostate-specific antigen (PSA) and digital rectal examination are standard for prostate cancer management.
- Limitations exist in serum PSA's ability to identify aggressive prostate cancer.
Purpose of the Study:
- To evaluate the clinical utility of urinary PSA levels for prostate cancer diagnosis.
- To compare the diagnostic performance of urinary PSA versus serum PSA in detecting aggressive prostate cancer.
Main Methods:
- Analyzed 437 urine specimens from prostate cancer patients using the Access Hybritech PSA assay.
- Validated findings with immunohistochemistry (IHC) on tumor tissues and metastatic lesions.
- Assessed predictive power using Area Under the Curve (AUC) analysis for urinary PSA, serum PSA, and their ratio.
Main Results:
- Aggressive prostate cancer cases showed lower urinary PSA and higher serum PSA levels.
- Urinary PSA demonstrated higher predictive power (AUC=0.732) for aggressive disease compared to serum PSA.
- Combining serum and urine PSA assays, along with their ratio, further enhanced prediction (AUC=0.811).
Conclusions:
- Urinary PSA may serve as a better indicator of aggressive prostate cancer than serum PSA.
- The combination of serum and urine PSA assays offers improved detection of aggressive prostate cancer.
