title: Prostate health index and prostate cancer gene 3 score but not percent-free Prostate Specific Antigen have a predictive role in differentiating histological prostatitis from PCa and other nonneoplastic lesions (BPH and HG-PIN) at repeat biopsy.
abstract: OBJECTIVE
  To determine if prostate health index (PHI), prostate cancer antigen gene 3 (PCA3) score, and percentage of free prostate-specific antigen (%fPSA) may be used to differentiate asymptomatic acute and chronic prostatitis from prostate cancer (PCa), benign prostatic hyperplasia (BPH), and high-grade prostate intraepithelial neoplasia (HG-PIN) in patients with elevated PSA levels and negative findings on digital rectal examination at repeat biopsy (re-Bx).
  
  
  METHODS
  In this prospective study, 252 patients were enrolled, undergoing PHI, PCA3 score, and %fPSA assessments before re-Bx. We used 3 multivariate logistic regression models to test the PHI, PCA3 score, 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 (4-10ng/ml) cohort (171 individuals).
  
  
  RESULTS
  Of the 252 patients, 43 (17.1%) had diagnosis of PCa. The median PHI was significantly different between men with a negative biopsy and those with a positive biopsy (34.9 vs. 48.1, P<0.001), as for the PCA3 score (24 vs. 54, P<0.001) and %fPSA (11.8% vs. 15.8%, P = 0.012). The net benefit of using PCA3 and PHI to differentiate prostatitis and PCa was moderate, although it extended to a good range of threshold probabilities (40%-100%), whereas that from using %fPSA was negligible: this pattern was reported for the whole population as for the "gray zone" PSA cohort.
  
  
  CONCLUSIONS
  In front of a good diagnostic performance of all the 3 biomarkers in distinguishing negative biopsy vs. positive biopsy, the clinical benefit of using the PCA3 score and PHI to estimate prostatitis vs. PCa was comparable. PHI was the only determinant for prostatitis vs. BPH, whereas no biomarkers could differentiate prostate inflammation from HG-PIN.
authors.affiliation: Division of Urology, San Luigi Gonzaga Hospital and University of Torino, Orbassano, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: De Luca
authors.affiliation: Division of Nuclear Medicine, San Giovanni Battista Hospital and University of Torino, Italy. Electronic address: rpassera@cittadellasalute.to.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Passera
authors.affiliation: Division of Urology, San Luigi Gonzaga Hospital and University of Torino, Orbassano, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Fiori
authors.affiliation: Division of Pathology, San Luigi Gonzaga Hospital and University of Torino, Orbassano, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Bollito
authors.affiliation: Division of Pathology, San Luigi Gonzaga Hospital and University of Torino, Orbassano, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Cappia
authors.affiliation: Division of Urology, San Luigi Gonzaga Hospital and University of Torino, Orbassano, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Mario 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
authors.initials: D
authors.lastname: Franco Randone
authors.affiliation: Division of Urology, San Luigi Gonzaga Hospital and University of Torino, Orbassano, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000951:Antigens, Neoplasm / Q000032:analysis*; D014408:Biomarkers, Tumor / Q000032:analysis*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000032:analysis; D011470:Prostatic Hyperplasia / Q000175:diagnosis; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D011472:Prostatitis / Q000175:diagnosis*
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; C479341:prostate cancer antigen 3, human; D017430:Prostate-Specific Antigen
keywords: Differential diagnosis; Percentage of free prostate-specific antigen; Prostate cancer; Prostate cancer antigen 3 gene; Prostate health index; Prostate-specific antigen; Prostatitis