title: Clinical use of [-2]proPSA (p2PSA) and its derivatives (%p2PSA and Prostate Health Index) for the detection of prostate cancer: a review of the literature.
abstract: Prostate-specific antigen (PSA) is recognized as an organ-specific marker with low specificity and sensitivity in discriminating prostate cancer (PCa) from other benign conditions, such as prostatic hyperplasia or chronic prostatitis. Thus, in the case of clinical suspicion, a PCa diagnosis cannot be made without a prostate biopsy. [-2]proPSA (p2PSA), a precursor of PSA, has been investigated as a new marker to accurately detect PCa. The aim of this systematic review was to discuss the available literature regarding the clinical validity and utility of p2PSA and its derivatives, p2PSA/fPSA (%p2PSA) and the Prostate Health Index (PHI). A systematic search of the PubMed and Scopus electronic databases was performed in accordance with the PRISMA statement (http://www.prisma-statement.org), considering the time period from January 1990 to January 2014 and using the following search terms: proprostate specific antigen, proenzyme PSA, proPSA, [-2]proPSA, p2PSA, Prostate Health Index, and PHI. To date, 115 studies have been published, but only 35 were considered for the qualitative analysis. These studies suggested that p2PSA is the most cancer-specific form of PSA, being preferentially expressed in PCa tissue and being significantly elevated in the serum of men with PCa. It is now evident that p2PSA, %p2PSA, and PHI measurements improve the specificity of the available tests (PSA and derivatives) in detecting PCa. Moreover, increasing PHI values seem to correlate with more aggressive disease. Some studies have compared p2PSA and its derivatives with other new biomarkers and found p2PSA to be significantly more accurate. Indeed, the implementation of these tests in clinical practice has the potential to significantly increase the physician's ability to detect PCa and avoid unnecessary biopsies, while also having an effective impact on costs. Further studies in large, multicenter, prospective trials are required to confirm these encouraging results on the clinical utility of these new biomarkers.
authors.affiliation: Department of Urology, Ville Turro, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Abrate
authors.affiliation: Department of Urology, Ville Turro, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lughezzani
authors.affiliation: Department of Urology, Ville Turro, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Giulio Maria
authors.initials: GM
authors.lastname: Gadda
authors.affiliation: Department of Urology, Ville Turro, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Lista
authors.affiliation: Department of Urology, Ville Turro, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Ella
authors.initials: E
authors.lastname: Kinzikeeva
authors.affiliation: Department of Urology, Ville Turro, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Fossati
authors.affiliation: Department of Urology, Ville Turro, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Larcher
authors.affiliation: Department of Urology, Ville Turro, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Dell'Oglio
authors.affiliation: Department of Urology, Ville Turro, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mistretta
authors.affiliation: Department of Urology, Ville Turro, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Nicolòmaria
authors.initials: N
authors.lastname: Buffi
authors.affiliation: Department of Urology, Ville Turro, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guazzoni
authors.affiliation: Department of Urology, Ville Turro, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Lazzeri
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D020033:Protein Isoforms / Q000097:blood; D011498:Protein Precursors / Q000097:blood*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: C583834:(-2)pro-prostate-specific antigen, human; D014408:Biomarkers, Tumor; D020033:Protein Isoforms; D011498:Protein Precursors; D017430:Prostate-Specific Antigen
keywords: Diagnosis; Prostate cancer; Prostate health index; [-2]proPSA