Clinical Application Of Serum P2PSA Combined With PSA And Cytokines In The Diagnosis Of Prostate Cancer

BackgroundProstate cancer(PCa)is a common tumor in elderly men.When the serum prostate specific antigen(PSA)is between 4 and 10μg/L gray area,it will increase unnecessary puncture,which bring difficulties to the diagnosis of PCa.Therefore,new markers are urgently needed to assist clinically diagnose of PCa in gray area.ObjectiveThe first purpose of this study was to investigate the diagnostic value of various serum markers such as isoform[-2]proprostate specific antigen,percentage of p2PSA(%p2PSA),prostate health index(PHI),Interleukin-6(IL-6),tumor necrosis factor-a(TNF-α)and Th17cell related cytokines in PCa with serum PS A 4～10μg/L.The second purpose was to discuss the expression and clinical significance of tPSA,fPSA,IL-6,TNF-α and IL-17A in peripheral blood of patients with PCa and their clinical significance.Whether tPSA,fPSA,IL-6,TNF-α and IL-17A are related to Gleason score and bone metastasis,and whether they can reflect the severity of the disease.METHOD1.60 patients with PSA 4～10μg/L,digital rectal examination(-)and prostate biopsy were selected.There were 23 cases of benigh prostatic hyperplasia(BPH)in the disease control group and 37 cases of PCa in the disease group.30 healthy men who underwent physical examination in Peking union medical college hospitial during the same period were selected as the healthy group(HC).Serum markers such as p2PSA、%p2PSA、PHI、tPSA、fPSA、IL-6、TNF-α IL-17A、IL-23、IL-36y were determined.p2PSA、%p2PSA、PHI、tPSA、fPSA were determined by ACCESS2 automatic biochemical immune analyzer.IL-6、TNF-α were immunized by IMMULITE1000 automatic analyzer.IL-17A、IL-23、IL-3 6y were detected by the Shanghai ELISA kit.2.77 patients with PSA>4μg/L who were diagnosed with PCa by prostate biopsy and underwent whole-body nuclide bone imaging.30 healthy men who underwent physical examination in Peking union medical college hospitial during the same period were selected as the HC.All samples were measured tPSA、fPSA、f、tPSA、IL-6、TNF-α、IL-17A.RESULT1.Samples with PSA in gray area were compared well between the Roche and Beckman system.There were difference in p2PSA,%p2PSA and PHI between the PCa group and BPH group,which contributed to the early diagnosis of PCa in grey area.The AUC values were 0.691,0.834 and 0.777,respectively.And was positively correlated with Gleason score,which could reduce unnecessary puncture.BPH group VS.HC group,the cytokines IL-6,TNF-α were statistical differences.PCa group VS.HC group,the cytokines of IL-6,TNF-α,IL-17A and IL-36γ statistical differences.However,there was no significant difference between PCa group and BPH group.2.The results of tPSA,fPSA,IL-6,TNF-α and IL-17A in the PCa group were significantly higher than the HC group.The results of tPSA and fPSA in the high-risk group of Gleason score were higher than those in the low-risk group,and those in the bone metastases group were higher than those in the non-metastases group.However,cytokines and f/tPSA were not showed singifiantly among the subgroup.CONCLUSION1.For PCa patients with PSA in the gray area of 4-10μg/L,p2PSA,%p2PSA and PHI not only assist clinical diagnosis,help clinical differentiation between PCa and BPH in the gray zone,reduce unnecessary puncture,but also predict the invasion of pathological differention.2.The level of tPSA,fPSA,IL-6,TNF-α,IL-17A in the peripheral blood of PCa patients increased significantly compared with HC group.However,the level of cytokines were not correlated with Gleason score,and bone metastasis.While the level of tPSA and fPSA were associated with Gleason scores and bone metastasis,were better indicators of disease severity.