{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T09:28:58Z","timestamp":1769246938527,"version":"3.49.0"},"reference-count":25,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>Context.\u2014<\/jats:title>\n                    <jats:p>There is a need to avoid the overdiagnosis of prostate cancer (PCa) and to find more specific biomarkers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective.\u2014<\/jats:title>\n                    <jats:p>To evaluate the clinical utility of [\u22122]pro\u2013prostate-specific antigen ([\u22122]proPSA) derivatives in detecting clinically significant PCa (csPCa) and to compare it with prostate-specific antigen (PSA) and with the percentage of free PSA (%fPSA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design.\u2014<\/jats:title>\n                    <jats:p>Two hundred thirty-seven men (PSA: 2\u201310 ng\/mL) scheduled for a prostate biopsy were enrolled. Parametric and nonparametric tests, receiver operating characteristic curves, and logistic regression analysis were applied. Outcomes were csPCa and overall PCa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results.\u2014<\/jats:title>\n                    <jats:p>Both [\u22122]proPSA derivatives were significantly higher in csPCa and overall PCa (P &amp;lt; .001). The areas under the curves for the prediction of csPCa were higher for the percentage of [\u22122]proPSA (%[\u22122]proPSA) (0.781) and the prostate health index (PHI) (0.814) than for PSA (0.651) and %fPSA (0.724). There was a gain of 11% in diagnostic accuracy when %[\u22122]proPSA or PHI were added to a base model with PSA and %fPSA. Twenty-five percent to 29% of biopsies could have been spared with %[\u22122]proPSA (cutoff: \u22651.25%) and PHI (cutoff: \u226527), missing 10% of csPCas. The same results could have been achieved by using [\u22122]proPSA as a reflex test, when %fPSA was 25% or less (cutoffs: \u22651.12% and \u226524 for %[\u22122]proPSA and PHI, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions.\u2014<\/jats:title>\n                    <jats:p>The [\u22122]proPSA derivatives improve the diagnostic accuracy of csPCa when the PSA value is between 2 and 10 ng\/mL, sparing unnecessary biopsies and selecting patients for active surveillance. [\u22122]proPSA can be used as a reflex test when %fPSA is 25% or less, without reducing the diagnostic accuracy for csPCa and the number of spared biopsies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5858\/arpa.2021-0079-oa","type":"journal-article","created":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T16:53:00Z","timestamp":1628009580000},"page":"691-700","source":"Crossref","is-referenced-by-count":13,"title":["The Percentage of [\u22122]Pro\u2013Prostate-Specific Antigen and the Prostate Health Index Outperform Prostate-Specific Antigen and the Percentage of Free Prostate-Specific Antigen in the Detection of Clinically Significant Prostate Cancer and Can Be Used as Reflex Tests"],"prefix":"10.5858","volume":"146","author":[{"given":"Manuel M.","family":"Garrido","sequence":"first","affiliation":[{"name":"From the Departments of Clinical Pathology (Garrido, Marta), Centro Hospitalar Universit\u00e1rio de Lisboa Central, Lisbon, Portugal."},{"name":"From the Department of Laboratory Medicine (Garrido), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal."}]},{"given":"Jos\u00e9 C.","family":"Marta","sequence":"additional","affiliation":[{"name":"From the Departments of Clinical Pathology (Garrido, Marta), Centro Hospitalar Universit\u00e1rio de Lisboa Central, Lisbon, Portugal."}]},{"given":"Rui M.","family":"Bernardino","sequence":"additional","affiliation":[{"name":"From the Department of Urology (Bernardino, Guerra, Fernandes, Pinheiro), Centro Hospitalar Universit\u00e1rio de Lisboa Central, Lisbon, Portugal."}]},{"given":"Jo\u00e3o","family":"Guerra","sequence":"additional","affiliation":[{"name":"From the Department of Urology (Bernardino, Guerra, Fernandes, Pinheiro), Centro Hospitalar Universit\u00e1rio de Lisboa Central, Lisbon, Portugal."}]},{"given":"Francisco","family":"Fernandes","sequence":"additional","affiliation":[{"name":"From the Department of Urology (Bernardino, Guerra, Fernandes, Pinheiro), Centro Hospitalar Universit\u00e1rio de Lisboa Central, Lisbon, Portugal."}]},{"given":"Maria H.","family":"Pereira","sequence":"additional","affiliation":[{"name":"From the Department of Pathologic Anatomy (Pereira), Centro Hospitalar Universit\u00e1rio de Lisboa Central, Lisbon, Portugal."},{"name":"From the Department of Pathologic Anatomy (Pereira), Faculdade de Ci\u00eancias M\u00e9dicas da Universidade Nova de Lisboa, Lisbon, Portugal."}]},{"given":"Ruy","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"From the Department of Biomathematics Laboratory (Ribeiro), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal."}]},{"given":"Stefan","family":"Holdenrieder","sequence":"additional","affiliation":[{"name":"From the Institute of Laboratory Medicine, Munich Biomarker Research Center, Deutsches Herzzentrum M\u00fcnchen, Technische Universit\u00e4t M\u00fcnchen, Munich, Germany (Holdenrieder)."}]},{"given":"Lu\u00eds C.","family":"Pinheiro","sequence":"additional","affiliation":[{"name":"From the Department of Urology (Bernardino, Guerra, Fernandes, Pinheiro), Centro Hospitalar Universit\u00e1rio de Lisboa Central, Lisbon, Portugal."},{"name":"From the Department of Urology (Pinheiro), Faculdade de Ci\u00eancias M\u00e9dicas da Universidade Nova de Lisboa, Lisbon, Portugal."}]},{"given":"Jo\u00e3o T.","family":"Guimar\u00e3es","sequence":"additional","affiliation":[{"name":"From the Department of Clinical Pathology, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o, Porto, Portugal (Guimar\u00e3es)."},{"name":"From the Department of Biomedicine, Faculdade de Medicina & EPIUnit, Instituto de Sa\u00fade P\u00fablica, Universidade do Porto, Porto, Portugal (Guimar\u00e3es)."}]}],"member":"3906","published-online":{"date-parts":[[2021,8,3]]},"reference":[{"key":"2022052715283174800_i1543-2165-146-6-691-b01","doi-asserted-by":"crossref","unstructured":"Siegel\n              RL,\n            \n            \n              Miller\n              KD,\n            \n            \n              Jemal\n              A.\n            \n          \n          Cancer statistics, 2020.\n\t\t\t\t\tCA Cancer J Clin.\n\t\t\t\t\t2020;\n\t\t\t\t\t70(1):\n\t\t\t\t\t7\u2013\n\t\t\t\t\t30.\n\t\t\t\t\tdoi:10.3322\/caac.21590","DOI":"10.3322\/caac.21590"},{"key":"2022052715283174800_i1543-2165-146-6-691-b02","unstructured":"EU Science Hub.\n          2020 Cancer incidence and mortality in EU-27 countries.\n\t\t\t\t\thttps:\/\/ec.europa.eu\/jrc\/en\/news\/2020-cancer-incidence-and-mortality-eu-27-countries. 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