title: Preoperative prostate-specific antigen isoform p2PSA and its derivatives, %p2PSA and prostate health index, predict pathologic outcomes in patients undergoing radical prostatectomy for prostate cancer.
abstract: BACKGROUND
  Currently available predictive models fail to assist clinical decision making in prostate cancer (PCa) patients who are possible candidates for radical prostatectomy (RP). New biomarkers would be welcome.
  
  
  OBJECTIVE
  Test the hypothesis that prostate-specific antigen (PSA) isoform p2PSA and its derivates, percentage of p2PSA to free PSA (%p2PSA) and the Prostate Health Index (PHI), predict PCa characteristics at final pathology after RP.
  
  
  METHODS
  An observational prospective study was performed in 350 consecutive men diagnosed with clinically localised PCa who underwent RP.
  
  
  METHODS
  We determined the predictive accuracy of serum total PSA (tPSA), free PSA (fPSA), fPSA-to-tPSA ratio (%fPSA), p2PSA, %p2PSA, and PHI. The primary end point was to determine the accuracy of these biomarkers in predicting the presence of pT3 disease, pathologic Gleason sum≥7, Gleason sum upgrading, and tumour volume<0.5 ml.
  
  
  METHODS
  Open retropubic and robot-assisted laparoscopic RP was performed. Pelvic lymphadenectomy was performed according to baseline oncologic parameters and the surgeon's judgement.
  
  
  CONCLUSIONS
  The %p2PSA and PHI levels were significantly higher in patients with pT3 disease, pathologic Gleason sum≥7, and Gleason sum upgrading (all p values<0.001). Conversely, %p2PSA and PHI levels were significantly lower in patients with tumour volume<0.5 ml (p<0.001). By univariate analysis, both %p2PSA and PHI were accurate predictors of pT3 disease, pathologic Gleason sum≥7, Gleason sum upgrading, and tumour volume<0.5 ml. By multivariate analyses, the inclusion of both %p2PSA and PHI significantly increased the predictive accuracy of a base multivariate model (excluding the tumour volume prediction for both variables, and Gleason sum upgrading for the model including %p2PSA) that included patient age, tPSA, fPSA, f/tPSA, clinical stage, and biopsy Gleason sum.
  
  
  CONCLUSIONS
  We found that p2PSA and its derivatives are predictors of PCa characteristics at final pathology after RP and are more accurate than currently available markers.
authors.affiliation: Department of Urology, San Raffaele Turro, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guazzoni
authors.forename: Massimo
authors.initials: M
authors.lastname: Lazzeri
authors.forename: Luciano
authors.initials: L
authors.lastname: Nava
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lughezzani
authors.forename: Alessandro
authors.initials: A
authors.lastname: Larcher
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Scattoni
authors.forename: Giulio Maria
authors.initials: GM
authors.lastname: Gadda
authors.forename: Vittorio
authors.initials: V
authors.lastname: Bini
authors.forename: Andrea
authors.initials: A
authors.lastname: Cestari
authors.forename: Nicolò Maria
authors.initials: NM
authors.lastname: Buffi
authors.forename: Massimo
authors.initials: M
authors.lastname: Freschi
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000601:surgery*; D020033:Protein Isoforms / Q000097:blood; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D020033:Protein Isoforms; D017430:Prostate-Specific Antigen