Diagnostic and prognostic efficiency of calculated complex prostate-specific antigen percentage (cPSA%) for prostate cancer and benign prostate hyperplasia

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Abstract Background Serum cPSA% provides evidence for prostate cancer (PCa) staging and differential diagnosis from benign prostatic hyperplasia (BPH). This study examined the effectiveness of the calculated cPSA% as a diagnostic and prognostic marker for PCa and to differentiate between PCa and BPH. Methods In a case-control study, serum total prostate-specific antigen (tPSA) and free prostate-specific antigen (fPSA) were measured in newly diagnosed PCa and BPH patients. The cPSA% and fPSA% were calculated. The sensitivity and specificity of the tPSA-faction isoforms were analyzed and evaluated in the study groups. Results In PCa, the average cPSA% was significantly higher and fPSA% was lower (86.0 ± 30.4% and 14.0 ± 3.50%, p < 0.001). In the all levels of tPSA, cPSA showed the highest sensitivity and fPSA higher specificity (69%, AUC: 0.723, and 72%, AUC: 0.253). In the tPSA range of 4–10 ng/ml, cPSA% and fPSA% have similar efficiency, whereas, at 10–50 ng/ml, cPSA noticed higher efficiency than fPSA (92%, AUC: 0.549 and 51%, AUC: 0.369). Conclusion The cPSA achieves the requirements of PCa biomarkers and has greater efficiency for the diagnosis of PCa and differentiating it from BPH in gray-zone and late stages.

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