The Percentage of Free PSA and Urinary Markers Distinguish Prostate Cancer from Benign Hyperplasia and Contribute to a More Accurate Indication for Prostate Biopsy

This study validated a quadruplex assay of urinary markers (PCA3, AMACR, TRPM8, and MSMB with KLK3 normalization) in a cohort of 299 men with serum PSA levels of 2.5–10 ng/mL to distinguish prostate cancer (CaP) from benign hyperplasia (BPH). The study found that AMACR, PCA3, TRPM8, and EZH2 mRNA expression, along with the percentage of free PSA, significantly differed between BPH and CaP. The best model combining % free PSA, PCA3, and AMACR achieved an AUC of 0.728, while a subset analysis with PCA3, % free PSA, EPCAM, and PSGR reached an AUC of 0.753. Although PCA3 mRNA increased with inflammation, it did not affect biopsy stratification. The findings suggested that % free PSA and urinary markers improved the accuracy of prostate biopsy indications.