A Prospective, Single-centre，Single-blinded Study of PROUD for Prostate Carcinoma Diagnosis
A Prospective, Single-centre，Single-blinded Study of PROUD for Prostate Carcinoma Diagnosis
Prostate carcinoma (PC) is common malignancy and is considered to be the highest incidence in
 the old males. The traditional diagnostic methods of PC present with some shortcomings. For
 example, the specificity of serum PSA remains low while prostate needle biopsy is invasive
 and false negative in some case, even causing missed diagnosis of some high risk PC, and over
 diagnosis of PC is not rare. Therefore, a noninvasive diagnostic method with high accuracy is
 urgently needed. Our previous study has proved that PROstate cancer Urine Detector (PROUD),
 which is able to detect chromosomal aberrations of the urine exfoliated cells, is a reliable
 method in diagnosing urothelial carcinoma with sensitivity and specificity of 82.5% and
 96.9%, respectively. But its potential in PC diagnosis hasn't been assessed yet and the
 accuracy of PROUD in detecting PC need to be validated. We here intended to investigate
 whether PROUD can be used in PC diagnosis and further validate the accuracy of PROUD in
 diagnosing PC.
The traditional diagnostic methods of PC include serum PSA and prostatic biopsy (PB). To
 screen the PC in high risk population, PSA is commonly used. The early detection of PC is
 actually carried out by the association of digital rectal examination (DRE) and serum total
 prostate-specific antigen (tPSA) level. The usual upper limit for tPSA is 4 ng ml-1. However,
 between 4 and 10 ng ml-1, there exists a diagnostic grey zone with an estimated probability
 of only 40% of PC in men with normal findings on DRE. Prostrate cancer can only be accurately
 differentiated from benign prostate hyperplasia(BPH) and prostatitis by pathological proof,
 usually obtained by subsequent invasive PB. To refine the indications for PB, and therefore
 to reduce morbidity, new indicators based on tPSA were developed: age-adjusted tPSA cutoffs,
 tPSA velocity or tPSA density where the elevated tPSA is indexed to the gland size. The most
 commonly used indicator is free/total PSA ratio (f/tPSA), which may help to predict PC or BPH
 in its extreme values. However, the probability of PC at biopsy among men with a PSA value
 between 4 and 10 ng ml-1 and normal findings on DRE ranged from 56% for men with an f/tPSA
 ratio of <10% to 8% for men with a ratio >25%, underlying the lack of accuracy of the f/tPSA
 indicator. PB is the "gold standard" diagnostic procedure, which is invasive, uncomfortable
 and with possible adverse side effects as local bleeding and infectious complications
 including drug resistant bacterial strains. Furthermore, repeated tissue biopsy is needed in
 some cases for the missed diagnosis of PC, in the other hand, causing over diagnosis of the
 insignificant clinical PC cases.

 The difficulty of estimating the risk of PC when there is a suspicious DRE without nodule,
 when tPSA ranges between 4 and 10 ng ml-1 or when f/tPSA has an average value (between 15 and
 25%), taken together with the morbidity due to PB, highlights the need of new predictive
 markers for PC.

 In urine samples, it is reported than whole-genome gene expression analysis, as noninvasive
 method, obtained from PC, BPH,and control groups by using the microarray system, showed the
 differences of gene expression profiles.To improve the specificity of prostate cancer
 diagnosis, prostate-cancer-specific markers, such as prostate cancer gene 3 (PCA3),are
 needed. The strong association between PCA3 mRNA overexpression and malignant transformation
 of prostate epithelium indicates its potential as a diagnostic biomarker. The PCA3 test of PC
 has a sensitivity ranged from 47%-69% and specificity from 72%-83%.

 Copy number variations (CNVs) refers to the ongoing acquisition of genomic alterations
 ranging from point mutations to gross chromosomal rearrangements, is a hallmark of cancer
 which is found in 60-80% of human cancer, and it positively correlates with high tumor stage,
 poor prognosis, metastasis and therapeutic resistance. Several researches have investigated
 the value of detecting chromosomal instability with sWGS in either cell-free (cf)DNA or
 genomic DNA as a noninvasive diagnostic method for cancers and yielded quite fine results.
 Our previous research has also proved the PROUD model reached performance of AUC=0.928, with
 sensitivity, specificity and accuracy of 82.5%, 96.9% and 89.0%, respectively. This test also
 showed superiority in diagnosing upper tract urothelial carcinoma compared with urinary
 cytology test.

 Here we intended to conduct a prospective, multicenter, single-blinded research to further
 validate the value of PROUD in diagnosing PC by analyzing the CNV level of patient DNA
 extracted from urine exfoliated cells.
Inclusion Criteria:

 -  Patients suspected with prostate cancer and planned to undergo prostate needle biopsy.

 -  Patient with serum PSA test result.

 -  Patient willing to provide morning urine sample before biopsy, and willing to provide
 patient information.

 -  Participants without any tumor disease and willing to attend the study by providing
 morning urine.

 -  Male patients aged >= 18 years.

 -  Participants signed informed consent form.

 Exclusion Criteria:

 -  Age under 18 years

 -  Individuals unwilling to sign the consent form or unwilling to provide morning urine
 for test or unwilling to provide the medical record.

 -  Patient already received urethral catheterization.

 -  Patient with late-stage uremia and need regular dialysis.

 -  Patient with urothelial carcinoma or suspected urothelial carcinoma.

 -  Suspected PC patient with endocrine therapy without histological results of the
 prostate.

 -  PC patient after any related therapy: endocrine therapy, radiotherapy, radical
 operation, immunotherapy, chemotherapy, transurethral prostate surgery, cryoablation
 or other local therapy.