Prostate health index and %p2PSA predict final pathological

outcomes in Italian patients undergoing radical

prostatectomy for prostate cancer
Stefano De Lucaa, Roberto Passerab, Enrico Bollitoc, Antonino Sottiled, Francesco
Porpigliaa

Urology and cPathology, San Luigi Gonzaga Hospital and University of Torino (Orbassano,

Italy)
b

Nuclear Medicine, San Giovanni Battista Hospital and University of Torino (senior

biostatistician)
d

Laboratory Medicine, Candiolo Cancer Institute, FPO-IRCCS (Candiolo, Italy)

Abstract
Introduction: Prostate cancer shows a considerably biological variability which hampers
accurate prediction of aggressiveness by current prognostic markers.
Many men with low-risk cancer are still treated actively and exposed to potential
complications such as incontinence and erectile dysfunction. In these men, active
surveillance may be more appropriate. New predictors are urgently awaited to improve
cancer classification, thus facilitating decision-making and patient counseling.
The aim of this study was to investigate the accuracy of prostate health index(PHI) and
%p2PSA in predicting pathological outcomes at radical prostatectomy(RP).
Patients and Methods: This is a prospective study on 132 patients. The accuracy of preoperative %p2PSA and PHI in predicting pathological outcomes of RP including
pathological T3(pT3), pathologic Gleason score (pGS)7, GS upgrade at RP (pGS higher
than biopsy GS), Tumor volume<0.5ml, and Epstein significant tumor (pT3, pGS7, or

tumor volume >0.2ml) were calculated using multivariate analyses and area under
curve(AUC). The base model in multivariate analysis included age, total PSA (tPSA),
Percentage free PSA(%fPSA), biopsy GS, and abnormal digital rectal examination (DRE).
Results: PHI was significantly higher in patients with

pT3 disease (p=0.021),

pGS7(p=0.005), GS upgraded (p=0.031), tumor volume >0.5m l(p<0.001), and Epstein

significant tumor (p<0.001). Similarly, %p2PSA was significantly higher in patients with pT3
(p=0.006), pGS7(p=0.004), GS upgraded (p=0.007), tumor volume >0.5ml (p=0.003), and
Epstein significant tumor (p<0.001). In multivariate analysis, adding %p2PSA or PHI to the
base model significantly improved the accuracy(AUC) in predicting pT3 (by 4.3-6.4%),
pGS7 (by 4.1-5.0%), GS upgrade(by 4.7-5.4%), tumor volume>0.5ml(by 8.9-10.4%), and
Epstein significant tumor (by 13.4-14.7%). In multivariate analysis, PHI cutoff 37 and
%p2PSA cutoff 1.6% were the only 2 independent predictors for pT3 and pGS7, and they
improved the AUC by 8.4%-8.9%(pT3) and 9.3-9.4%(pGS7). In decision curve analysis
for pT3 and pGS7, a net clinical benefit was observed.
Conclusions: Both PHI and %p2PSA could play an interesting role to predict significant
disease improving predictive accuracy of RP pathological outcomes.

References
1. Jansen FH, vanSchaik RHN, Kurstjens J, et al.: Prostate-specific antigen (PSA)
isoform p2PSA in combination with total PSA and free PSA improves diagnostic
accuracy in prostate cancer detection. Eur Urol 2010; 57(6): 921-7.
2. Le BV, Griffin CR, Loeb S, et al.: [-2]Proenzyme prostate specific antigen is more
accurate than total and free prostate specific antigen in differentiating prostate
cancer from benign disease in a prospective prostate cancer screening study. J Urol
2010; 183(4): 1355-9.
3. Guazzoni G, Lazzeri M, Nava L, et al.: Preoperative prostate-specific antigen
isoform p2PSA and its derivatives, %p2PSA and prostate health index, predict
pathologic outcomes in patients undergoing radical prostatectomy for prostate
cancer. Eur Urol 2012; 61(3): 455-66.