Filamin A Is a Prognostic Serum Biomarker for Differentiating Benign Prostatic Hyperplasia from Prostate Cancer in Caucasian and African American Men

Simple Summary Prostate Cancer represents a significant health risk for men, especially African American men, despite the availability of PSA testing. Although PSA testing is the current gold-standard test for identifying at-risk men, an increased PSA level may arise from Benign Prostatic Hyperplasia instead of Prostate Cancer. For men with BPH, PSA testing may lead them to undergo unnecessary biopsies. As an alternative to PSA, we have previously described a Filamin-A and prostate volume based biomarker test with superior performance. To simplify this test, we removed the requirement of prostate volume measurement. Herein, we present results of this updated test utilizing Filamin-A alone in Caucasian and African American men. Filamin-A demonstrates superior predictive power compared to PSA in both patient populations. By reliably separating benign conditions from aggressive prostate cancer, this test would reduce the health care burden resulting from unnecessary prostate biopsies.Abstract Prostate cancer represents a significant health risk to aging men, in which diagnostic challenges to the identification of aggressive cancers remain unmet. Prostate cancer screening is driven by the prostate-specific antigen (PSA); however, in men with benign prostatic hyperplasia (BPH) due to an enlarged prostate and elevated PSA, PSA's screening utility is diminished, resulting in many unnecessary biopsies. To address this issue, we previously identified a cleaved fragment of Filamin A (FLNA) protein (as measured with IP-MRM mass spectrometry assessment as a prognostic biomarker for stratifying BPH from prostate cancer and subsequently evaluated its expanded utility in Caucasian (CA) and African American (AA) men. All men had a negative digital rectal examination (DRE) and PSA between 4 and 10 ng/mL and underwent prostate biopsy. In AA men, FLNA serum levels exhibited diagnostic utility for stratifying BPH from patients with aggressive prostate cancer (0.71 AUC and 12.2 OR in 48 men with BPH and 60 men with PCa) and outperformed PSA (0.50 AUC, 2.2 OR). In CA men, FLNA serum levels also exhibited diagnostic utility for stratifying BPH from patients with aggressive prostate cancer (0.74 AUC and 19.4 OR in 191 men with BPH and 109 men with PCa) and outperformed PSA (0.46 AUC, 0.32 OR). Herein, we established FLNA alone as a serum biomarker for stratifying men with BPH vs. those with high Gleason (7-10) prostate cancers compared to the current diagnostic paradigm of using PSA. This approach demonstrates clinical actionability of FLNA alone without the requirement of prostate volume measurement as a test with utility in AA and CA men and represents a significant opportunity to decrease the number of unnecessary biopsies in aggressive prostate cancer diagnoses.