Analysis of the Predictive Value of the Prostate-specific Antigen-to-neutrophil Ratio for the Diagnosis of Prostate Cancer

Overview

Journal Discov Oncol

Publisher Springer

Specialty Oncology

Date 2025 Jan 6

PMID 39762493

Authors

Yuxuan Chen

Haisheng Yan

Yaoqin Xu

Kexin Chen

Runqin Yang

Jiali Yang

Ruian Zhu

Rui Lin

Jiang Wang

Jie Liu

Pingsheng Gao

Lei Pang

Lexin Wang

Affiliations

Soon will be listed here.

Abstract

Background: Currently, serum PSA is the most commonly used screening tool in clinical practice. However, PSA levels in the range of 4-10 ng/ml are considered the 'grey zone' of prostate cancer screening. Patients within this range need to be further evaluated using additional parameters such as PSA ratio, PSA density, and other indices to determine the necessity of prostate biopsy (PBx). Despite this, patients in the 'grey zone' still have a low rate of positive biopsy results. Neutrophils have been found to be associated with tumor development and inflammation. Based on this, we combined PSA and absolute neutrophil counts to calculate the total PSA to absolute neutrophil ratio (PNR), which is higher in patients with prostate cancer and lower in those with benign conditions. PNR is elevated in prostate cancer patients compared to those with prostate enlargement. Therefore, the aim of this study is to explore the diagnostic efficacy of PNR for prostate cancer across different PSA intervals and to provide new insights into the diagnosis, treatment, and screening strategies for prostate cancer.

Objective: In this study, we explored the predictive value of prostate-specific antigen-to-neutrophil ratio (PNR) for the diagnosis of prostate cancer, with a view to further improving the diagnostic accuracy of prostate cancer.

Methods: Patients were grouped in three different divisions of PSA 4-10 ng/ml, 10-20 ng/ml, > 20 ng/ml, We grouped the patients and compared the test data such as age, PSA, PSA-density (PSAD), and prostate-specific antigen-to-neutrophil ratio (PNR) between the two groups of patients who had puncture results of prostate cancer and non-prostate cancer at the same time using Log regression test to verify the diagnostic value of PNR.

Results: When PSA levels are in the range of 4-10 ng/ml, an elevated PNR is an independent risk factor for prostate cancer. In this range, the diagnostic value of f/t PSA and PSAD for prostate cancer is limited. However, the use of PNR can significantly enhance the diagnostic efficacy for prostate cancer and thereby effectively reduce the incidence of unnecessary prostate biopsies.

References

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

Chen R, Rumble R, Jain S . Active Surveillance for the Management of Localized Prostate Cancer (Cancer Care Ontario guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement Summary. J Oncol Pract. 2018; 12(3):267-269. DOI: 10.1200/JOP.2015.010017. View

Hamdy F, Donovan J, Athene Lane J, Mason M, Metcalfe C, Holding P . 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. N Engl J Med. 2016; 375(15):1415-1424. DOI: 10.1056/NEJMoa1606220. View

Hugosson J, Roobol M, Mansson M, Tammela T, Zappa M, Nelen V . A 16-yr Follow-up of the European Randomized study of Screening for Prostate Cancer. Eur Urol. 2019; 76(1):43-51. PMC: 7513694. DOI: 10.1016/j.eururo.2019.02.009. View

Roobol M, Kranse R, Bangma C, van Leenders A, Blijenberg B, van Schaik R . Screening for prostate cancer: results of the Rotterdam section of the European randomized study of screening for prostate cancer. Eur Urol. 2013; 64(4):530-9. DOI: 10.1016/j.eururo.2013.05.030. View

Liu B, Pan T . Role of PSA-related variables in improving positive ratio of biopsy of prostate cancer within serum PSA gray zone. Urologia. 2014; 81(3):173-6. DOI: 10.5301/urologia.5000051. View

Caverly T, Hayward R, Reamer E, Zikmund-Fisher B, Connochie D, Heisler M . Presentation of Benefits and Harms in US Cancer Screening and Prevention Guidelines: Systematic Review. J Natl Cancer Inst. 2016; 108(6):djv436. PMC: 5009951. DOI: 10.1093/jnci/djv436. View

Coussens L, Werb Z . Inflammation and cancer. Nature. 2002; 420(6917):860-7. PMC: 2803035. DOI: 10.1038/nature01322. View

Fujita K, Imamura R, Tanigawa G, Nakagawa M, Hayashi T, Kishimoto N . Low serum neutrophil count predicts a positive prostate biopsy. Prostate Cancer Prostatic Dis. 2012; 15(4):386-90. DOI: 10.1038/pcan.2012.27. View

10.

Kawahara T, Fukui S, Sakamaki K, Ito Y, Ito H, Kobayashi N . Neutrophil-to-lymphocyte ratio predicts prostatic carcinoma in men undergoing needle biopsy. Oncotarget. 2015; 6(31):32169-76. PMC: 4741667. DOI: 10.18632/oncotarget.5081. View

11.

Kim J, Jung E, Kim J, Lee H, Kwag S, Park J . Dynamic changes of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio predicts breast cancer prognosis. BMC Cancer. 2020; 20(1):1206. PMC: 7720486. DOI: 10.1186/s12885-020-07700-9. View

12.

Thompson D, Perry L, Renouf J, Vodanovich D, Hong Lee A, Dimiri J . Prognostic utility of inflammation-based biomarkers, neutrophil-lymphocyte ratio and change in neutrophil-lymphocyte ratio, in surgically resected lung cancers. Ann Thorac Med. 2021; 16(2):148-155. PMC: 8109682. DOI: 10.4103/atm.ATM_382_20. View

13.

Erdogan B, Kostek O, Hacioglu M, Gokyer A, Kucukarda A, Ozcan E . Is early change in systemic inflammatory markers associated with treatment response in patients who received pazopanib?. J BUON. 2021; 26(5):2196-2201. View

14.

Wang H, Ding Y, Li N, Wu L, Gao Y, Xiao C . Prognostic Value of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, and Combined Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Stage IV Advanced Gastric Cancer. Front Oncol. 2020; 10:841. PMC: 7317009. DOI: 10.3389/fonc.2020.00841. View

15.

Rich N, Parvathaneni A, Sen A, Odewole M, Arroyo A, Mufti A . High Neutrophil-Lymphocyte Ratio and Delta Neutrophil-Lymphocyte Ratio Are Associated with Increased Mortality in Patients with Hepatocellular Cancer. Dig Dis Sci. 2021; 67(6):2666-2676. DOI: 10.1007/s10620-021-07001-6. View

16.

Toledano-Fonseca M, Cano M, Inga E, Gomez-Espana A, Guil-Luna S, Garcia-Ortiz M . The Combination of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio with Liquid Biopsy Biomarkers Improves Prognosis Prediction in Metastatic Pancreatic Cancer. Cancers (Basel). 2021; 13(6). PMC: 7998484. DOI: 10.3390/cancers13061210. View

17.

Ingenito A, Ennis R, Hsu I, Begg M, Benson M, Schiff P . Re-examining the role of prostate-specific antigen density in predicting outcome for clinically localized prostate cancer. Urology. 1997; 50(1):73-8. DOI: 10.1016/S0090-4295(97)00202-1. View

18.

Benson M, Whang I, Olsson C, McMahon D, COONER W . The use of prostate specific antigen density to enhance the predictive value of intermediate levels of serum prostate specific antigen. J Urol. 1992; 147(3 Pt 2):817-21. DOI: 10.1016/s0022-5347(17)37394-9. View

19.

Feng Z, Xue C, Wen J, Li Y, Wang M, Zhang N . PSAD Test in the Diagnosis of Prostate Cancer: a Meta-Analysis. Clin Lab. 2017; 63(1):147-155. DOI: 10.7754/Clin.Lab.2016.160727. View

20.

Hong S, Oh J, Byun S, Hwang S, Choo M, Lee S . Value of prostate-specific antigen (PSA) mass ratio in the detection of prostate cancer in men with PSA levels of ≤10 ng/mL. BJU Int. 2011; 110(2 Pt 2):E81-5. DOI: 10.1111/j.1464-410X.2011.10764.x. View