Preoperative prostate health index and %p2PSA as the significant biomarkers of postoperative pathological outcomes of prostate cancer in Korean males: A prospective multi-institutional study

• Main Authors: Hongzoo Park, Sang Wook Lee, Geehyun Song, Tae Wook Kang, Jae Hung Jung, Hyun Chul Chung, Sung Jin Kim, Jong Yeon Park, Tae Young Shin, Jeong Hyun Kim
• Format: Article
• Language: English
• Published: Korean Urological Association 2020-01-01
• Series: Investigative and Clinical Urology
• Subjects: pathology; prostatectomy; prostatic neoplasms
• Online Access: https://www.icurology.org/Synapse/Data/PDFData/2020ICU/icu-61-42.pdf
• ISSN: 2466-0493; 2466-054X

Purpose: To evaluate the clinical utility of percentage of serum prostate-specific antigen (proPSA) to free PSA (%p2PSA) and the prostate health index (PHI) for predicting aggressive pathological outcomes of radical prostatectomy (RP) in Korean males. Materials and Methods: This prospective observational multicenter study included 160 Korean males who consecutively underwent RP. The predictive utility of preoperative %p2PSA and PHI for predicting the following pathological outcomes of RP including pT3 disease, pathologic Gleason sum ≥7, and Gleason sum upgrading was investigated using multivariate and decision-curve analyses. Results: The PHI and %p2PSA levels were significantly higher in patients with pT3 disease, pathologic Gleason sum ≥7, and Gleason sum upgrading. On univariate analysis, PHI was an accurate predictor of pT3 disease, pathologic Gleason sum ≥7, and Gleason sum upgrading. Multivariate and decision curve analyses revealed that inclusion of PHI to a base multivariate model including total PSA, percentage free PSA, PSA density, percentage of positive biopsy core, biopsy Gleason sum, and clinical stage factors significantly increased its predictive accuracy; %p2PSA showed a similar result. However, PHI was a more valuable predictor of pathological outcomes of RP. Conclusions: This study revealed PHI and %p2PSA as preoperative biomarkers of pathological outcomes in Korean males who underwent RP for prostate cancer.