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        Clinical Use of [-2]proPSA (p2PSA) and Its Derivatives (%p2PSA and Prostate Health Index) for the Detection of Prostate Cancer: A Review of the Literature

        Alberto Abrate,Giovanni Lughezzani,Giulio Maria Gadda,Giuliana Lista,Ella Kinzikeeva,Nicola Fossati,Alessandro Larcher,Paolo Dell’Oglio,Francesco Mistretta,Nicolòmaria Buffi,Giorgio Guazzoni,Massimo L 대한비뇨의학회 2014 Investigative and Clinical Urology Vol.55 No.7

        Prostate-specific antigen (PSA) is recognized as an organ-specific marker with low specificityand sensitivity in discriminating prostate cancer (PCa) from other benign conditions,such as prostatic hyperplasia or chronic prostatitis. Thus, in the case of clinicalsuspicion, a PCa diagnosis cannot be made without a prostate biopsy. [-2]proPSA(p2PSA), a precursor of PSA, has been investigated as a new marker to accurately detectPCa. The aim of this systematic review was to discuss the available literature regardingthe clinical validity and utility of p2PSA and its derivatives, p2PSA/fPSA (%p2PSA)and the Prostate Health Index (PHI). A systematic search of the PubMed and Scopuselectronic databases was performed in accordance with the PRISMA statement(http://www.prisma-statement.org), considering the time period from January 1990 toJanuary 2014 and using the following search terms: proprostate specific antigen, proenzymePSA, proPSA, [-2]proPSA, p2PSA, Prostate Health Index, and PHI. To date,115 studies have been published, but only 35 were considered for the qualitativeanalysis. These studies suggested that p2PSA is the most cancer-specific form of PSA,being preferentially expressed in PCa tissue and being significantly elevated in the serumof men with PCa. It is now evident that p2PSA, %p2PSA, and PHI measurementsimprove the specificity of the available tests (PSA and derivatives) in detecting PCa. Moreover, increasing PHI values seem to correlate with more aggressive disease. Somestudies have compared p2PSA and its derivatives with other new biomarkers and foundp2PSA to be significantly more accurate. Indeed, the implementation of these tests inclinical practice has the potential to significantly increase the physician’s ability to detectPCa and avoid unnecessary biopsies, while also having an effective impact on costs. Further studies in large, multicenter, prospective trials are required to confirm theseencouraging results on the clinical utility of these new biomarkers.

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