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Background  This study aimed to explore the diagnostic value of alpha-l-fucosidase (AFU) in prostate cancer (PCa) patients with “gray-zone PSA” and to investigate the correlation between AFU expression and clinicopathological characteristics of PCa patients.    Methods  The level of AFU and other necessary clinicopathological variables of patients were retrieved from electronic medical records. The transcriptome profiling and clinical information of PCa patients were obtained from The Cancer Genome Atlas (TCGA) database. The protein level of AFU in tissue was assessed by immunohistochemistry (IHC). All the data were processed by appropriate analysis methods. The p-value of <0.05 was considered statistically significant.    Results  AFU showed ideal diagnostic value for PCa with prostate-specific antigen (PSA) levels ranging from 4 to 10 ng/ml, and its optimal cutoffs were 19.5 U/L. Beyond this, low AFU expression was associated with high pathological grade, T stage and N stage, more postoperative residual tumors, and poor primary therapy outcome, as well as shorter progression-free interval. The Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis illustrated that FUCA1/FUCA2 exerted tumor-suppressive function by regulating the glycosylation.    Conclusions  AFU (<19.5 U/L) could effectively distinguish the PCa from the patients with “gray-zone PSA”, and low expression of AFU was an independent unfavorable predictor for the clinicopathological characteristics of PCa patients.

Alpha-L-Fucosidase Has Diagnostic Value in Prostate Cancer With “Gray-Zone PSA” and Inhibits Cancer Progression via Regulating Glycosylation