Diagnostic Stratification of Prostate Cancer Through Blood-Based Biochemical and Inflammatory Markers

Background: Prostate cancer (PCa) remains one of the most prevalent malignancies in men, with diagnostic challenges arising from the limited specificity of current biomarkers, like PSA. Improved stratification tools are essential to reduce overdiagnosis and guide personalized patient management. Objective: This study aimed to identify and validate clinical and hematological biomarkers capable of differentiating PCa from benign prostatic hyperplasia (BPH) and precancerous lesions (PL) using univariate and multivariate statistical methods. Methods: In a cohort of 514 patients with suspected PCa, we performed a univariate analysis (Kruskal-Wallis and ANOVA) with preprocessing via adaptive Box-Cox transformation and missing value imputation through probabilistic principal component analysis (PPCA). LASSO regression was used for variable selection and classification. An ROC curve analysis assessed diagnostic performance. Results: Five variables-age, PSA, Index %, hemoglobin (HGB), and the International Index of Erectile Function (IIEF)-were consistently significant across univariate and multivariate analyses. The LASSO regression achieved a classification accuracy of 70% and an AUC of 0.74. Biplot and post-hoc analyses confirmed partial separation between PCa and benign conditions. Conclusions: The integration of multivariate modeling with reconstructed clinical data enabled the identification of blood-based biomarkers with strong diagnostic potential. These routinely available, cost-effective indicators may support early PCa diagnosis and patient stratification, reducing unnecessary invasive procedures.