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JU INSIGHT: Usefulness of LacdiNAc-glycosylated Prostate-specific Antigen Density for Predicting Pathological Findings of Magnetic Resonance Imaging-transrectal Ultrasound Fusion Image-guided Prostate Biopsy for the Patients With Highest Prostate Imaging Reporting and Data System Category ≥3

By: Sunao Shoji, MD, PhD, MBA; Takatoshi Kaya, PhD; Yumiko Tanaka; Kohei Uemura, PhD; Taku Kusaka; Kumpei Takahashi, MD; Soichiro Yuzuriha, MD; Tatsuo Kano, MD; Izumi Hanada, MD; Tatsuya Umemoto, MD; Takahiro Ogawa, MD; Mayura Nakano, MD; Masayoshi Kawakami, MD; Masahiro Nitta, MD, PhD; Masanori Hasegawa, MD, PhD; Kazunobu Hashida, MD; Terumitsu Hasebe, MD, PhD; Tomonori Kaneko; Jun Okada; Satomi Asai, MD, PhD; Akira Miyajima, MD, PhD | Posted on: 17 Jan 2023

Shoji S, Kaya T, Tanaka Y, et al. Usefulness of LacdiNAc-glycosylated prostate-specific antigen density for predicting pathological findings of magnetic resonance imaging-transrectal ultrasound fusion image-guided prostate biopsy for the patients with highest Prostate Imaging Reporting and Data System category ≥3. J Urol. 2023;209(1):187-197.

Figure. Two types of plasma prostate-specific antigen (PSA) and the measurement of plasma LacdiNAc-glycosylated–PSA value. a, Aberrant N-glycosylation of PSA. Plasma PSA derived from prostate cancer is LacdiNAc (N-acetylgalactosamine β1-4 N-acetylglucosamine) glycans at the nonreducing termini of N-glycan; this is not the case for plasma PSA derived from benign prostate tissue. b, Differences of LDN-PSA density (PSAD) between the patients who were detected with or without clinically significant prostate cancer using the Mann–Whitney U test. LDN-PSAD was significantly higher in the patients who were detected with clinically significant prostate cancer (median 20.0×10−4 U/mL/cc, range 1.73-95.6) than in the patients without clinically significant prostate cancer (median 6.05×10−4 U/mL/cc, range 0.910-73.5; P < .0001).

Study Need and Importance

LacdiNAc-glycosylated prostate-specific antigen (LDN-PSA) is a PSA carrying a prostate cancer (PC)–associated disaccharide LacdiNAc (GalNAcβ1 → 4GlcNAc) at the nonreducing termini of N-glycan. The present study evaluated the usefulness of the plasma LDN-PSA for detecting clinically significant PC (csPC) and predicting pathological findings of multiparametric magnetic resonance imaging (mpMRI)-transrectal ultrasound fusion image-guided target biopsy.

What We Found

On multivariable logistic regression analysis, PSA density (PSAD; odds ratio [OR] 1.61, P = .010), LDN-PSAD (OR 1.04, P = .012), highest Prostate Imaging–Reporting and Data System (PI-RADS) category (3 vs 4, 5; OR 14.5, P < .0001) and location of the lesion with highest PI-RADS category (transition zone vs peripheral zone; OR 0.34, P = .009) were significant risk factors for detecting csPC in all patients (n=204). On multivariable logistic regression analysis to predict the detection of csPC in patients with highest PI-RADS category 3 (n=113), age (OR 1.10, P = .026) and LDN-PSAD (OR 1.07, P < .0001) were significant risk factors for detecting csPC. LDN-PSA and LDN-PSAD had positive correlations with highest PI-RADS category. There were positive correlations between the highest Gleason score and LDN-PSA tumor density and PI-RADS category.

Limitations

This was a single-institution study. Second, the pathological results were diagnosed with MRI-transrectal ultrasound fusion image-guided target biopsy for suspicious lesions on mpMRI and 12-core systematic biopsy with a transperineal approach but not with whole-gland specimens. Third, the included patients were limited to those with PSA levels ≤20 ng/mL and cancer suspicious lesions with PI-RADS category ≥3.

Interpretation for Patient Care

The use of LDN-PSAD as an adjunct to the use of PSA levels would avoid unnecessary biopsies in patients with the highest PI-RADS category 3. Further, the various forms of LDN-PSA has the possibility to contribute to assess the effect and recurrence after the focal therapy for localized PC, because it would contribute to detect csPC (see Figure).

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