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Prostate cancer (PCa) is one of the most frequently diagnosed cancers and the leading cause of cancer death in males worldwide. Although prostate-specific antigen (PSA) screening has considerably improved the detection of PCa, it has also led to a dramatic increase in overdiagnosing indolent disease due to its low specificity. This study aimed to develop and validate a multivariate diagnostic model based on the urinary epithelial cell adhesion molecule (EpCAM)-CD9–positive extracellular vesicles (EVs) (uEV EpCAM-CD9 ) to improve the diagnosis of PCa.    Methods  We investigated the performance of uEV EpCAM-CD9  from urine samples of 193 participants (112 PCa patients, 55 benign prostatic hyperplasia patients, and 26 healthy donors) to diagnose PCa using our laboratory-developed chemiluminescent immunoassay. We applied machine learning to training sets and subsequently evaluated the multivariate diagnostic model based on uEV EpCAM-CD9  in validation sets.    Results  Results showed that uEV EpCAM-CD9  was able to distinguish PCa from controls, and a significant decrease of uEV EpCAM-CD9  was observed after prostatectomy. We further used a training set (N = 116) and constructed an exclusive multivariate diagnostic model based on uEV EpCAM-CD9 , PSA, and other clinical parameters, which showed an enhanced diagnostic sensitivity and specificity and performed excellently to diagnose PCa [area under the curve (AUC) = 0.952, P &amp;lt; 0.0001]. When applied to a validation test (N = 77), the model achieved an AUC of 0.947 (P &amp;lt; 0.0001). Moreover, this diagnostic model also exhibited a superior diagnostic performance (AUC = 0.917, P &amp;lt; 0.0001) over PSA (AUC = 0.712, P = 0.0018) at the PSA gray zone.    Conclusions  The multivariate model based on uEV EpCAM-CD9  achieved a notable diagnostic performance to diagnose PCa. In the future, this model may potentially be used to better select patients for prostate transrectal ultrasound (TRUS) biopsy.

A Multivariate Diagnostic Model Based on Urinary EpCAM-CD9-Positive Extracellular Vesicles for Prostate Cancer Diagnosis