Diagnostic Performance of %[-2]proPSA and Prostate Health Index for Prostate Cancer: Prospective, Multi-institutional Study

Background: We evaluated the clinical performance of [-2] proPSA (p2PSA) and its derivatives in predicting the presence and aggressiveness of prostate cancer (PCa) in Korean men. Methods: A total of 246 men with total prostate-specific antigen (tPSA) >= 3.5 ng/mL who underwent their first prostate biopsy were included in this prospective, multicenter, observational study. Diagnostic accuracy of tPSA, free-to-total PSA ratio (% fPSA), p2PSA, % p2PSA, and the Beckman Coulter prostate health index (PHI) was assessed by receiver operating characteristic curve analyses and logistic regression analyses. Results: Overall, PCa was detected in 125 (50.8%) subjects. In men with tPSA 3.5-10 ng/mL, the detection rate of PCa was 39.4% (61/155). In this group, PHI and % p2PSA were the most accurate predictors of PCa and significantly outperformed tPSA and % fPSA; area under the curve for tPSA, % fPSA, % p2PSA, and PHI was 0.56, 0.69, 0.74, and 0.76, respectively. PHI was also the strongest predictor of PCa with Gleason score >= 7. Conclusion: This study demonstrates the superior clinical performance of % p2PSA and PHI in predicting the presence and aggressiveness of PCa in Korean men. The % p2PSA and PHI appear to improve detection of PCa and provide prognostic information.