Significance of Inflammation Markers to Predict Curative Treatment for Prostate Cancer Patients on Active Surveillance

Abstract

Purpose: Active surveillance (AS) strategy aims to avoid unnecessary or excessive early treatment in patients at a low risk for prostate cancer (PCa). However, a biomarker that can predict the need for early curative treatment in patients under AS has not been identified to date. In this study, we aimed to investigate the potential of inflammatory biomarkers in predicting the requirement of curative treatment in the early period in patients under AS.

Materials and methods: This study included a total of 83 patients with the diagnosis of PCa and under AS. Patient age, prostate-specific antigen (PSA) level, prostate volume (PV), PSA density (PSAD), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), systemic immune-inflammation index (SII) and follow-up period were compared between the groups.

Results: There was a significant difference between the two groups in terms of PSAD, NLR, PLR and SII (p = 0.037, p = 0.046, p = 0.008, p = 0.004 and p = 0.005, respectively). The cut-off value determined by performing ROC analysis to evaluate the levels that predict the need for curative treatment before AS was 0.125 for PSAD (sensitivity: 61.8%, specificity: 61.2%), 2.01 for NLR (sensitivity: 67.6%, specificity: 55.1%), 115.49 for PLR (sensitivity: 73.5%, specificity: 59.2%) and 465.40 for SII (sensitivity: 70.6%, specificity: 59.2%).

Conclusions: The analysis of PSAD, NLR, PLR and SII before making the decision to conduct AS can guide clinicians regarding curative treatment in the early period.

Keywords: active surveillance; biomarkers; inflammation mediators; prostatic neoplasms; tumor.

FIGURE 1

Flow chart of patients included and not included in the study.

FIGURE 2

ROC graph of PSAD, NLR, PLR and SII to evaluate their efficacy in predicting the need for curative treatment in patients with PCa under AS.