Abstract
Prostate Cancer (PCa) diagnosis using PSA alone leads to unnecessary biopsy due to the non-specificity of PSA for PCa. Changes in systemic inflammation variables with the development and progression of PCa cancer have been widely acknowledged. This study evaluated the potential utility of ratios involving changes in serum PSA with changes in systemic inflammatory components: serum albumin, C-reactive protein, and full blood count differentials, to differentially predict PCa biopsy in a cohort of pre-biopsy patients. Methods: We prospectively analyzed data from 110 patients who underwent prostate biopsy between September 2022 and September 2023. Age, PSA, full blood count, serum albumin (ALB), serum C-reactive protein (CRP) and biopsy pathology results of the patients were analyzed. Based on biopsy findings, patients were grouped as benign prostatic hyperplasia (BPH) and PCa. Results: Analyses of ratios involving PSA and the selected inflammatory markers led to wider discriminating values between PCa and BPH. The mean PSA-to-ALB, PSA-to-Hb and PSA-to-CRP ratios were significantly lower in the BPH group compared with the PCa group. AUROC curves analysis at cut-off points of PSA-ALB˃1, PSA-CRP˃250 and PSA-Hb˃2.5 resulted in specificity and positive predictive values for PSA-to-ALB ratio of 93% and 91% respectively, PSA-to-Hb ratio of 86% and 80% respectively and PSA-to-CRP ratio of 78% and 77% respectively. Unconditional regression analysis showed that PSA-to-CRP, PSA-to-Hb and PSA-to-ALB ratios were independent predictors of positive PCa biopsy. Conclusion: This preliminary study suggests that, the combination of PSA with changes in serum inflammatory variables in ratios improved the diagnostic accuracy more than the use of PSA alone. These ratios may assist in the differential prediction of PCa and BPH, especially where biopsy services are not readily available in Low- and Middle-Income countries.