Beyond PSA-Can Systemic Inflammatory Indices Improve Prostate Cancer Detection?

Area of Science:

• Urology
• Oncology
• Clinical Diagnostics

Background:

• Prostate-specific antigen (PSA) is a key biomarker for prostate cancer (PCa) detection, but its low specificity causes unnecessary biopsies.
• Systemic inflammatory indices (SII, SIRI, AISI, NLR) from blood tests are explored as adjunctive tools for PCa diagnosis.
• Evaluating these indices' diagnostic performance in patients with suspected PCa is crucial.

Purpose of the Study:

• To assess the diagnostic utility of systemic inflammatory indices in patients undergoing prostate biopsy for elevated PSA.
• To compare the performance of various inflammatory indices against PSA for PCa detection.
• To investigate the role of inflammatory markers in predicting PCa presence.

Main Methods:

• Retrospective analysis of 307 patients undergoing prostate biopsy for elevated PSA (Jan 2021-Jan 2023).
• Calculation of neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), Systemic Inflammation Response Index (SIRI), and aggregate index of systemic inflammation (AISI).
• Logistic regression and ROC analyses to determine diagnostic performance and predictive accuracy.

Main Results:

• Prostate cancer (PCa) was diagnosed in 65.1% of patients.
• Elevated AISI demonstrated diagnostic performance comparable to PSA.
• Integrating inflammatory indices into models improved predictive accuracy for PCa presence, but not for distinguishing tumor aggressiveness.

Conclusions:

• Systemic inflammatory indices are associated with PCa presence and can enhance diagnostic performance when used with PSA.
• These indices serve as complementary tools, offering limited value in risk stratification.
• Inflammatory markers are not suitable as standalone diagnostic tests for prostate cancer.