Serum levels of PSA, ALP, ICTP, and BSP in prostate cancer patients and the significance of ROC curve in the diagnosis of prostate cancer bone metastases

Abstract

ABSTRACT. Bone metastasis is a common complication in prostate cancer patients that can cause bone pain and pathological fracture. This study tested serum levels of prostate specific antigen (PSA), alkaline phosphatase (ALP), bone sialoprotein (BSP), collagen type I pyridine crosslinking peptide (ICTP) in prostate cancer patients and the significance of the receiver operator characteristic (ROC) curve in the diagnosis of prostate cancer bone metastases. Eighty-three prostate cancer patients were enrolled including 42 in the bone metastases group and 41 in the non-bone metastases group. Serum levels of BSP, ALP, ICTP, and PSA were highest in the bone metastases group followed by the non-bone metastases group, hyperplasia group, and then the control group (P < 0.05). Based on Gleason score, serum levels were highest in the poorly differentiated group followed by moderately differentiated and well-differentiated groups (P < 0.05). ROC curve analysis revealed that the diagnostic efficiency of the biomarkers in turn was BSP, PSA, ICTP, and ALP. The sensitivity of BSP, ALP, ICTP, and PSA in the diagnosis of prostate cancer bone metastases were 80.95, 57.14, 69.05, 71.43%, respectively, and the specificity of the same markers were 72. 80, 64.80, 76.80, and 88.80%, respectively. Combined detection of the four markers improved sensitivity to 97.62% and the negativepredictive value increased to 97.60%. PSA + BSP showed the best efficiency when combining two markers. In conclusion, serum levels of BSP, ALP, ICTP, and PSA increased in patients with bone metastases, and combined detection of all markers could improve the positivepredictive value.

Aplicações da curva ROC em estudos clínicos e experimentais

“…4,5 Classificatory systems based on clinical symptoms, diagnostic scales, radiological findings, assays of different substances and, primarily, choice of the optimal cutoff points to maximize the performance of diagnostic tests are the most common applications for ROC curves. [6][7][8][9][10][11] Figure 1A illustrates an example of a hypothetical test with high sensitivity and high specificity for diagnostic classification. This hypothetical test (test 1) has two distribution curves for the test results of sick and healthy individuals.…”

Prognostic Significance of Free Psa/ Total Psa Ratio In Predicting Bone Metastases In Patients With Prostate Cancer

“…[28,29] A correlation has been investigated between bone metastasis and PSA level, ALP level and Gleason score, and consequently, correlations at varying levels have been mentioned in the literature. [30][31][32] Some authors recommended the use of bone scan in symptomatic patients or if alkaline phosphatase levels are > 90 U/l. [33] The authors described correlation between PSA value and both presence and number of metastases with a cutoff value of PSA of 10 ng/ml for negative bone scans.…”

SB225002 inhibits prostate cancer invasion and attenuates the expression of BSP, OPN and MMP‑2

“…Studies over recent years have suggested that, besides MMP family proteins, small integrin binding ligand N-linked glycoproteins (SIBLINGs) also regulate many of the activities required for the distant metastasis of tumor cells, especially for malignant bone metastases. Additionally, the serum levels of BSP and OPN (two primary proteins of the SIBLING family and the most frequently investigated) are often used to predict the occurrence of bone metastases ( 2 , 7 , 9 – 11 ). As mentioned previously, BSP and OPN contain an integrin-binding RGD (Arg-Gly-Asp) sequence that can bind to integrins to enhance the invasion and adhesion of tumor cells ( 29 ).…”

“…SIBLINGs are overexpressed in many cancers ( 2 , 6 – 8 ). The level of SIBLING protein in serum is often used to predict the prognosis of many cancer patients, especially in patients with prostate and breast cancer ( 9 – 11 ). Two proteins in this family, namely, OPN (osteopontin) and BSP (bone sialoprotein), have garnered the most attention, and their reported levels of expression are closely correlated with tumor aggressiveness.…”