J Cancer 2017; 8(7):1223-1228. doi:10.7150/jca.18012 This issue

Research Paper

PSA and Prostate Health Index based prostate cancer screening in a hereditary migration complicated population: implications in precision diagnosis

Mariyam Akizhanova1*, Elzira E. Iskakova2*, Valdemir Kim1*, Xiao Wang3, Roman Kogay1#, Aiym Turebayeva1#, Qinglei Sun3, Ting Zheng3, Shenghui Wu4, Lixia Miao5, Yingqiu Xie1✉

1. Department of Biology, School of Science and Technology, Nazarbayev University, Astana, 010000, Republic of Kazakhstan;
2. Module of Pathological Anatomy, Kazakh National Medical University, Almaty, 050000, Republic of Kazakhstan;
3. Shandong Analysis and Test Center, Shandong Academy of Sciences, 19 keyuan Street, Jinan, 250014, P.R. China;
4. Department of Epidemiology & Biostatistics, University of Texas Health at San Antonio Laredo Campus, Laredo, TX 78041, USA;
5. College of Basic Medicine, Wuhan University, Wuhan, 430071, P.R. China.
* Co-first authors
# Contributed equally

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) license (https://creativecommons.org/licenses/by-nc/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Akizhanova M, Iskakova EE, Kim V, Wang X, Kogay R, Turebayeva A, Sun Q, Zheng T, Wu S, Miao L, Xie Y. PSA and Prostate Health Index based prostate cancer screening in a hereditary migration complicated population: implications in precision diagnosis. J Cancer 2017; 8(7):1223-1228. doi:10.7150/jca.18012. Available from https://www.jcancer.org/v08p1223.htm

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Precision diagnosis requires specific markers for differential ethnic populations. Prostate-Specific Antigen (PSA) level (threshold of 4ng/ml) has been widely used to screen prostate cancer and as reference of pro-biopsy but false diagnosis frequently occurs. Prostate health Index (PHI) is a new diagnosis marker which combines PSA, free PSA and p2PSA4. Overall the PCa screening database is lacking in Kazakhstani patients. We analyzed the PSA levels and Gleason scores of 222 biopsies collected in 2015 in Almaty area, Kazakhstan approved by institutional ethics board. We found using PSA of 4ng/ml as threshold, only 25.68% of patients have cancer with Gleason score ranged 6-8 and 65.77% of patients have no character of cancer. Moreover, there is no significant correlation between PSA and cancerous (P=0.266) or Gleason grade (P=0.3046) based on pathological biopsy. In addition, PHI is not correlated to prostate cancer (P=0.4301). Our data suggest that false-positive rate is much higher than the correct-positive diagnosis when using PSA as the first screening. Thus in this cohort study, most patients can not get benefit from the PSA screening for precision PCa diagnosis. As Kazakhstani family trees are unique and complicated because of history and migration, the high rate of over diagnosis might be due to the hyperexpression of PSA via heterosis in Eurasian men. Therefore we should be cautious when using pro-biopsy in precision diagnosis for Eurasian prostate cancer patients.

Keywords: PSA, prostate cancer, precision medicine, diagnosis.