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Serum early prostate cancer antigen (EPCA) as a significant predictor of incidental prostate cancer in patients undergoing transurethral resection of the prostate for benign prostatic hyperplasia
Author(s) -
Zhao Zhigang,
Zeng Guohua,
Zhong Wen
Publication year - 2010
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.21215
Subject(s) - medicine , prostate cancer , prostate , urology , biomarker , hyperplasia , oncology , proportional hazards model , cancer , gastroenterology , biochemistry , chemistry
BACKGROUND Early prostate cancer antigen (EPCA), a nuclear matrix protein, has been recently suggested as a novel biomarker in malignant lesions of the prostate. This study was to determine whether preoperative serum EPCA levels predicted the presence of incidental prostate cancer (IPCa) in patients undergoing TURP for BPH. METHODS Serum EPCA levels were measured by ELISA in 449 consecutive patients with symptomatic BPH treated with TURP and 112 healthy men. Predictive performance of serum EPCA levels for IPCa were evaluated. RESULTS With a cutoff of 10 ng/ml, serum EPCA protein had a 100% specificity for the healthy men and a 98% specificity and a 100% sensitivity in separating men with IPCa from those without. Serum EPCA levels in patients with IPCa were significantly higher than in those without and in healthy controls (17.63 ± 2.42 ng/ml vs. 5.58 ± 1.61 ng/ml and 4.95 ± 1.43 ng/ml, all P < 0.001), whereas an indwelling transurethral catheter presence and 5α‐reductase inhibitor therapy had no effect on EPCA levels ( P = 0.144 and P = 0.238, respectively). The area under ROC curves (AUC) showed that serum EPCA level had the best predictive accuracy of all IPCa (AUC: 0.952, 95% CI: 0.912–0.981, P < 0.001). Univariate and multivariate Cox regression analyses further demonstrated the independently predictive performance by preoperative serum EPCA (Hazards Ratio: 4.23, 95% CI: 3.62–6.46, P < 0.001). CONCLUSIONS This study firstly shows that EPCA might be used as a highly sensitive and specific serum biomarker to predict IPCa presence and to help reduce the unnecessary biopsies taken before TURP in patients with BPH. Prostate 70: 1788–1798, 2010. © 2010 Wiley‐Liss, Inc.