Correlation between a Serum and Urinary Annexin A3 in Iraqi Patients with Prostate Cancer and Benign Prostatic Hyperplasia

Abstract

Background: Prostate-specific antigen [PSA] considered as a prostate cancer biomarker. However, limited sensitivity and
specificity, leading to unnecessary biopsies, over diagnosis and overtreatment of patients. Urine Annexin A3 is a potential
protein biomarker that can be measured in a non-invasive way for prostate cancer to facilitate PCa diagnosis. Aims of the
study: To evaluate the urinary Annexin A3 [ANXA3] test as a potential new additional biomarker for prostate cancer
diagnosis. Materials and Methods: A case-control study comprising 54 patients over 50 years old age with Prostate
Cancer and Benign Prostatic Hyperplasia who were recruited from Iraqi urological clinics unit and AL- Amal National
Hospital for Cancer Management during the period from July 2018 to March 2019. Blood and urine specimens from these
patients were collected before obtaining a prostatic biopsy. Serum PSA, fPSA%, Annexin A3and Urine Annexin A3 levels
were quantified by ELISA technique. Urine Annexin A3 levels were normalized by both urinary normalization factors
specific gravity and creatinine. Results: There was a highly significant difference [P< 0.001] in serum and urine Annexin
A3 levels among all the study groups. The cut- off values of serum and urine Annexin A3 based on the ROC curve results
in current study were ≤ 23.9 ng/ml and ≤19.8 ng/ml respectively in Prostate cancer patients, while their values range
between 23.9 - 29.66 ng/ml and 19.8 - 26.8 ng/ml respectively in BPH patients, and >29.66 ng/ml and >26.8 ng/ml
respectively for apparently healthy men in a sample of Iraqi patients. A highly significant positive correlation was found
between S. ANX3 and U. ANX3 [P=0.000, r = 0.908] in Prostate Cancer group,[ P = 0.000, r = 0.662 ] in BPH group and
[P = 0.000,r = 0.690] in control group respectively. Urinary specific gravity consistently performed as the best or nearly the
best adjustment method relative to urinary creatinine for the urinary levels of Annexin A3 normalization based on the ROC
curve comparison results. Conclusions: Annexin A3 has an inverse relationship with Prostate Cancer, Annexin A3
quantification in serum and urine provides a new, noninvasive PCa biomarkers with high specificity and sensitivity.