Urinary Epithelial Cell Adhesion Molecule (EpCAM) as a Noninvasive Biomarker for Detecting Clinically Significant...

Area of Science:

• Urology
• Oncology
• Biomarker Discovery

Background:

• Prostate-specific antigen (PSA) screening has limited specificity in the 4-10 ng/mL range, leading to unnecessary prostate biopsies.
• A diagnostic
• grey zone
• for PSA necessitates improved noninvasive biomarkers.

Purpose of the Study:

• Evaluate urinary epithelial cell adhesion molecule (EpCAM), normalized to creatinine (EpCAM/Cr), as a noninvasive biomarker.
• Identify clinically significant prostate cancer (csPCa) in men with equivocal PSA levels (4-10 ng/mL).

Main Methods:

• Cross-sectional study of 286 men with PSA 4-10 ng/mL undergoing prostate biopsy.
• Quantified urinary EpCAM via ELISA and assessed diagnostic performance for csPCa using ROC curves and logistic regression.
• Classified histopathological outcomes using ISUP Grade Groups.

Main Results:

• Urinary EpCAM/Cr levels were significantly higher in men with csPCa (p < 0.001) and correlated with tumor aggressiveness (ρ = 0.609, p < 0.001).
• EpCAM/Cr demonstrated strong discrimination for csPCa (AUC = 0.816), outperforming serum PSA and PSA density.
• EpCAM/Cr and PSA density were independent predictors of csPCa in multivariable analysis.

Conclusions:

• Urinary EpCAM/Cr is a promising noninvasive biomarker for csPCa detection in the diagnostic PSA grey zone.
• This biomarker may aid in reducing unnecessary prostate biopsies.