title: Improving the prediction of pathologic outcomes in patients undergoing radical prostatectomy: the value of prostate cancer antigen 3 (PCA3), prostate health index (phi) and sarcosine.
abstract: OBJECTIVE
  Several efforts have been made to find biomarkers that could help clinicians to preoperatively determine prostate cancer (PCa) pathological characteristics and choose the best therapeutic approach, avoiding over-treatment. On this effort, prostate cancer antigen 3 (PCA3), prostate health index (phi) and sarcosine have been presented as promising tools. We evaluated the ability of these biomarkers to predict the pathologic PCa characteristics within a prospectively collected contemporary cohort of patients who underwent radical prostatectomy (RP) for clinically localized PCa at a single high-volume Institution.
  
  
  METHODS
  The prognostic performance of PCA3, phi and sarcosine were evaluated in 78 patients undergoing RP for biopsy-proven PCa. Receiver operating characteristic (ROC) curve analyses tested the accuracy (area under the curve (AUC)) in predicting PCa pathological characteristics. Decision curve analyses (DCA) were used to assess the clinical benefit of the three biomarkers.
  
  
  RESULTS
  We found that PCA3, phi and sarcosine levels were significantly higher in patients with tumor volume (TV)≥0.5 ml, pathologic Gleason sum (GS)≥7 and pT3 disease (all p-values≤0.01). ROC curve analysis showed that phi is an accurate predictor of high-stage (AUC 0.85 [0.77-0.93]), high-grade (AUC 0.83 [0.73-0.93]) and high-volume disease (AUC 0.94 [0.88-0.99]). Sarcosine showed a comparable AUC (0.85 [0.76-0.94]) only for T3 stage prediction, whereas PCA3 score showed lower AUCs, ranging from 0.74 (for GS) to 0.86 (for TV).
  
  
  CONCLUSIONS
  PCA3, phi and sarcosine are predictors of PCa characteristics at final pathology. Successful clinical translation of these findings would reduce the frequency of surveillance biopsies and may enhance acceptance of active surveillance (AS).
authors: Division of Urology, European Institute of Oncology, Milan, Italy.
authors: Matteo
authors: M
authors: Ferro
authors: Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, Bari, Italy.
authors: Giuseppe
authors: G
authors: Lucarelli
authors: Department of Public Health, IRCCS Fondazione G. Pascale, Naples, Italy.
authors: Dario
authors: D
authors: Bruzzese
authors: Urology Unit, IRCCS Fondazione G. Pascale, Naples, Italy.
authors: Sisto
authors: S
authors: Perdonà
authors: Department of Translational Medical Sciences, University "Federico II", Naples, Italy.
authors: Claudia
authors: C
authors: Mazzarella
authors: Department of Translational Medical Sciences, University "Federico II", Naples, Italy.
authors: Giuseppe
authors: G
authors: Perruolo
authors: Department of Translational Medical Sciences, University "Federico II", Naples, Italy.
authors: Ada
authors: A
authors: Marino
authors: Department of Translational Medical Sciences, University "Federico II", Naples, Italy.
authors: Vincenzo
authors: V
authors: Cosimato
authors: Department of Translational Medical Sciences, University "Federico II", Naples, Italy.
authors: Emilia
authors: E
authors: Giorgio
authors: Department of Translational Medical Sciences, University "Federico II", Naples, Italy.
authors: Virginia
authors: V
authors: Tagliamonte
authors: Division of Urology, European Institute of Oncology, Milan, Italy.
authors: Danilo
authors: D
authors: Bottero
authors: Division of Urology, European Institute of Oncology, Milan, Italy.
authors: Ottavio
authors: O
authors: De Cobelli
authors: Department of Translational Medical Sciences, University "Federico II", Naples, Italy daniela.terracciano@unina.it.
authors: Daniela
authors: D
authors: Terracciano
mesh_terms: D000951:Antigens, Neoplasm / Q000378:metabolism*; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D012372:ROC Curve; D012521:Sarcosine / Q000378:metabolism*
chemical_list: D000951:Antigens, Neoplasm; C479341:prostate cancer antigen 3, human; D012521:Sarcosine
keywords: Gleason score; PCA3; phi; sarcosine; tumor stage; tumor volume