title: Comparison of prostate cancer gene 3 score, prostate health index and percentage free prostate-specific antigen for differentiating histological inflammation from prostate cancer and other non-neoplastic alterations of the prostate at initial biopsy.
abstract: OBJECTIVE
  To determine if prostate cancer gene 3 (PCA3) score, Prostate Health Index (PHI), and percent free prostate-specific antigen (%fPSA) may be used to differentiate prostatitis from prostate cancer (PCa), benign prostatic hyperplasia (BPH) and high-grade prostate intraepithelial neoplasia (HG-PIN) in patients with elevated PSA and negative digital rectal examination (DRE).
  
  
  METHODS
  in the present prospective study, 274 patients, undergoing PCA3 score, PHI and %fPSA assessments before initial biopsy, were enrolled. Three multivariate logistic regression models were used to test PCA3 score, PHI and %fPSA as risk factors for prostatitis vs. PCa, vs. BPH, and vs. HG-PIN. All the analyses were performed for the whole patient cohort and for the 'gray zone' of PSA (4-10 ng/ml) cohort (188 individuals).
  
  
  RESULTS
  The determinants for prostatitis vs. PCa were PCA3 score, PHI and %fPSA (Odds Ratio [OR]=0.97, 0.96 and 0.94, respectively). Unit increase of PHI was the only risk factor for prostatitis vs. BPH (OR=1.06), and unit increase of PCA3 score for HG-PIN vs. prostatitis (OR=0.98). In the 'gray zone' PSA cohort, the determinants for prostatitis vs. PCa were PCA3 score, PHI and %fPSA (OR=0.96, 0.94 and 0.92, respectively), PCA3 score and PHI for prostatitis vs. BPH (OR=0.96 and 1.08, respectively), and PCA3 score for prostatitis vs. HG-PIN (OR=0.97).
  
  
  CONCLUSIONS
  The clinical benefit of using PCA3 score and PHI to estimate prostatitis vs. PCa was comparable; even %fPSA had good diagnostic performance, being a faster and cheaper marker. PHI was the only determinant for prostatitis vs. BPH, while PCA3 score for prostatitis vs. HG-PIN.
authors.affiliation: Division of Urology, San Luigi Gonzaga Hospital and University of Torino, Orbassano, Torino, Italy delucastefano@yahoo.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: De Luca
authors.affiliation: Division of Nuclear Medicine, San Giovanni Battista Hospital and University of Torino, Torino, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Passera
authors.affiliation: Division of Pathology, San Luigi Gonzaga Hospital and University of Torino, Orbassano, Torino, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Bollito
authors.affiliation: Division of Urology, San Luigi Gonzaga Hospital and University of Torino, Orbassano, Torino, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Manfredi
authors.affiliation: Division of Urology, San Luigi Gonzaga Hospital and University of Torino, Orbassano, Torino, Italy.
authors.forename: Roberto Mario
authors.initials: RM
authors.lastname: Scarpa
authors.affiliation: Division of Laboratory Medicine, Candiolo Cancer Institute, Candiolo, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Sottile
authors.affiliation: Division of Urology, Gradenigo Hospital, Torino, Italy.
authors.forename: Donato Franco
authors.initials: DF
authors.lastname: Randone
authors.affiliation: Division of Urology, San Luigi Gonzaga Hospital and University of Torino, Orbassano, Torino, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000951:Antigens, Neoplasm / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood*; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011470:Prostatic Hyperplasia / Q000097:blood / Q000473:pathology; D019048:Prostatic Intraepithelial Neoplasia / Q000097:blood / Q000473:pathology; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology*; D011472:Prostatitis / Q000097:blood / Q000473:pathology*
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; C479341:prostate cancer antigen 3, human; D017430:Prostate-Specific Antigen
keywords: Prostate Health Index; Prostate cancer; differential diagnosis; percentage free prostate-specific antigen; prostate cancer antigen 3 gene; prostate-specific antigen; prostatitis