Serum Ferritin's Diagnostic And Prognostic Values In Prostate Cancer

BackgroundFerritin is the major iron storage protein in the body.High serum ferritin levels have been associated with increased risk of many cancer lineages,including liver,breast,lung cancers.There are a variety of studies that have shown elevated serum ferritin levels are significantly associated with the risk of multiple cancers.This study aims to explore the relationship between serum ferritin and prostate cancer risk as well as its diagnostic and prognostic values in the disease.MethodsWe performed a case-control study consisting of 2002 prostate cancer(PCa)patients and 951 benign prostatic hyperplasia(BPH)controls.All clinical data including serum ferritin,serum prostate-specific antigen(PSA),Gleason score were collected at The First Affiliated Hospital of Zhejiang University from 2011 to 2015.We examined the expression level of ferritin in 129 prostate cancer tissues and 31 benign prostatic hyperplasia tissues using the staining of immunohistochemistry(IHC).ResultsWe found high ferritin levels were positively associated with increased serum PSA and PCa risk(OR=1.20,95%CI:1.13-1.36;per 100ng/mL).Consistent with Gleason score,total PSA,serum ferritin levels had a positive correlation with lymph node invasion,distant metastasis in PCa patients.Besides,elevated serum ferritin levels were significantly correlated with high Gleason scores(P for trend<0.001).Notably,an improved predictive accuracy was observed when using serum PSA in PCa patients with hyperferritinemia(serum ferritin>400ng/mL)(Gleason score?total PSA,R=0.38;Gleason score?free PSA,R=0.49).Further,we analyzed prostate ferritin levels in 129 PCa compared with those from 31 BPH controls by immunohistochemistry.Consistently,prostate tissue ferritin levels were significantly elevated in PCa patients with increased cancer stages(P<0.001).In addition,the prostate tissue ferritin levels were well correlated with serum ferritin classified by cancer stages(R=0.81).Importantly,we found no relationship between serum ferritin and inflammation marker C-reactive protein(CRP)in PCa patients.ConclusionSerum ferritin is significantly associated with prostate cancer and has diagnostic(especially for those patients with serum ferritin>400ng/mL,age>65 years)and prognostic values in prostate cancer.Serum ferritin could serve as a complementary biomarker to improve the PSA test in prognosis of prostate cancer.