CC BY-NC-ND 4.0 · J Lab Physicians 2023; 15(02): 237-242
DOI: 10.1055/s-0042-1757723
Original Article

Utility of Prostate-Specific Antigen Isoforms and Prostate Health Index in the Diagnosis of Metastatic Prostate Cancer

Govinda Nanjaiah Laxmana Raju
1   Biochemistry Section, Laboratory Services, Apollo Hospitals, Bengaluru, Karnataka, India
2   Department of Biochemistry and Biotechnology, Annamalai University, Annamalainagar, Tamil Nadu, India
3   Department of Biochemistry, St. Peter's Medical College, Hospital and Research Institute, Krishnagiri, Tamil Nadu, India
Siddavaram Nagini
2   Department of Biochemistry and Biotechnology, Annamalai University, Annamalainagar, Tamil Nadu, India
› Author Affiliations


Objective The current study was undertaken to investigate the utility of total prostate-specific antigen (tPSA), its isoform [-2] proPSA (p2PSA), and prostate health index (PHI) in the diagnosis of metastatic prostate cancer (PCa).

Materials and Methods This study was conducted from March 2016 to May 2019. Eighty-five subjects who were diagnosed with PCa for the first time, following transrectal ultrasound-guided prostate biopsy, were included in the study. The prebiopsy blood samples were analyzed in Beckman Coulter Access-2 Immunoanalyzer for tPSA, p2PSA, and free PSA (fPSA), and the calculated parameters included %p2PSA, %fPSA, and PHI. Mann–Whitney's U test was used as test of significance, and p-value less than 0.05 was considered statistically significant.

Results Of the 85 participants, 81.2% (n = 69) had evidence of metastasis, both clinically and pathologically. The median tPSA (ng/mL), p2PSA (pg/mL), %p2PSA, and PHI were significantly higher in the group with evidence of metastasis (46.5 vs. 13.76; 198.0 vs. 35.72; 3.25 vs. 1.51; 237.58 vs. 59.74, respectively). The sensitivity (%), specificity (%), negative predictive value (%), and positive predictive value (%) to diagnose metastatic PCa of tPSA at a cutoff of 20 ng/mL, PHI at a cutoff of 55, and %p2PSA at a cutoff of 1.66 were 92.7, 98.5, and 94.2; 37.5, 43.7, and 62.5; 54.5, 87.5, and 71.4; and 86.4, 88.3, and 91.5, respectively.

Conclusion Using tests such as %p2PSA and PHI in the standard armamentarium for the diagnosis of metastatic PCa in addition to PSA will help in selecting the appropriate treatment strategy, including active surveillance.

Authors' Contribution

G.N.L. contributed to study concept, design, acquisition analysis and interpretation of data, drafting the article, and revising it critically for intellectual content. P.P.B. drafted the article and revised it critically for intellectual content. S.N. guided, designed, and approved the final version to be published.

Publication History

Article published online:
20 October 2022

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