title: Prostate health index (phi) and prostate cancer antigen 3 (PCA3) significantly improve diagnostic accuracy in patients undergoing prostate biopsy.
abstract: BACKGROUND
  Prostate health index (phi) and prostate cancer antigen 3 (PCA3) have been recently proposed as novel biomarkers for prostate cancer (PCa). We assessed the diagnostic performance of these biomarkers, alone or in combination, in men undergoing first prostate biopsy for suspicion of PCa.
  
  
  METHODS
  One hundred sixty male subjects were enrolled in this prospective observational study. PSA molecular forms, phi index (Beckman coulter immunoassay), PCA3 score (Progensa PCA3 assay), and other established biomarkers (tPSA, fPSA, and %fPSA) were assessed before patients underwent a 18-core first prostate biopsy. The discriminating ability between PCa-negative and PCa-positive biopsies of Beckman coulter phi and PCA3 score and other used biomarkers were determined.
  
  
  RESULTS
  One hundred sixty patients met inclusion criteria. %p2PSA (p2PSA/fPSA × 100), phi and PCA3 were significantly higher in patients with PCa compared to PCa-negative group (median values: 1.92 vs. 1.55, 49.97 vs. 36.84, and 50 vs. 32, respectively, P ≤ 0.001). ROC curve analysis showed that %p2PSA, phi, and PCA3 are good indicator of malignancy (AUCs = 0.68, 0.71, and 0.66, respectively). A multivariable logistic regression model consisting of both the phi index and PCA3 score allowed to reach an overall diagnostic accuracy of 0.77. Decision curve analysis revealed that this "combined" marker achieved the highest net benefit over the examined range of the threshold probability.
  
  
  CONCLUSIONS
  phi and PCA3 showed no significant difference in the ability to predict PCa diagnosis in men undergoing first prostate biopsy. However, diagnostic performance is significantly improved by combining phi and PCA3.
authors: Urology Unit, IRCCS Fondazione G. Pascale, Napoli, Italy.
authors: Sisto
authors: S
authors: Perdonà
authors: Dario
authors: D
authors: Bruzzese
authors: Matteo
authors: M
authors: Ferro
authors: Riccardo
authors: R
authors: Autorino
authors: Ada
authors: A
authors: Marino
authors: Claudia
authors: C
authors: Mazzarella
authors: Giuseppe
authors: G
authors: Perruolo
authors: Michele
authors: M
authors: Longo
authors: Rosa
authors: R
authors: Spinelli
authors: Giuseppe
authors: G
authors: Di Lorenzo
authors: Andrea
authors: A
authors: Oliva
authors: Marco
authors: M
authors: De Sio
authors: Rocco
authors: R
authors: Damiano
authors: Vincenzo
authors: V
authors: Altieri
authors: Daniela
authors: D
authors: Terracciano
mesh_terms: D000368:Aged; D000951:Antigens, Neoplasm / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood*; D001706:Biopsy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology* / Q000502:physiology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; C479341:prostate cancer antigen 3, human; D017430:Prostate-Specific Antigen