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Can serum angiogenin be used to improve the diagnostic performance in prostate cancer screening?

Pina, Franciscoa,e; Botelho, Franciscoa,d; Lopes, Tiagoa,e; Lopes, Ivoa,e; Figueiredo, Gabrielab; Portugal, Raquelc; Ferro, Anaf; Cruz, Franciscoa,e; Barros, Henriqued,f; Lunet, Nunod,f

European Journal of Cancer Prevention: May 2014 - Volume 23 - Issue 3 - p 166–172
doi: 10.1097/CEJ.0b013e3283647453
Research Papers: Prostate Cancer

Several biomarkers have been studied to avoid unnecessary biopsies resulting from suboptimal performance of prostate-specific antigen (PSA) testing. We aimed to assess the use of serum angiogenin as a prostate cancer diagnostic tool among candidates for biopsy. We selected 252 patients referred for ultrasound-guided transrectal prostate biopsy on the basis of an abnormal digital rectal examination and/or elevated total PSA. Serum angiogenin was quantitatively analyzed by solid-phase enzyme-linked immunosorbent assay. Results of the prostatic pathology assessment (cancer vs. noncancer) were defined by biopsy. The median serum angiogenin levels were significantly higher in patients with prostate cancer (median: 487 500 vs. 414 800 pg/ml, P=0.008). Among patients with baseline tPSA of 4.0 ng/ml or less, 37.5% had serum angiogenin less than 389 000 pg/ml (sensitivity: 88.9%; specificity: 45.2%), and the probability of having prostate cancer varied from 22.5% before testing to 6.7% among those with low angiogenin levels. When further restricting the analyses to a group of patients with even lower probability of having cancer, on the basis of tPSA and f/t PSA values, the evaluation of serum angiogenin did not contribute toward a meaningful variation in the post-test probability of cancer. In conclusion, serum angiogenin levels may be useful to distinguish between cancer and noncancer patients among the candidates for prostatic biopsy in regular clinical practice. Further investigation is needed among patients with low PSA levels and to understand the relation between this biomarker and the long-term survival of prostate cancer patients.

Departments of aUrology


cPathology, S. João Hospital

dDepartment of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School

eDepartment of Urology, University of Porto Medical School

fInstitute of Public Health, University of Porto (ISPUP), Porto, Portugal

Correspondence to Nuno Lunet, MPH, PhD, Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal Tel: +351 225513652; fax: +351 225513653; e-mail:

Received March 31, 2013

Accepted June 20, 2013

© 2014 Lippincott Williams & Wilkins, Inc.