Analysis of the predictive value of the prostate-specific antigen-to-neutrophil ratio for the diagnosis of prostate cancer

Yuxuan Chen; Haisheng Yan; Yaoqin Xu; Kexin Chen; Runqin Yang; Jiali Yang; Ruian Zhu; Rui Lin; Jiang Wang; Jie Liu; Pingsheng Gao; Lei Pang; Lexin Wang

doi:10.1007/s12672-025-01760-8

Analysis of the predictive value of the prostate-specific antigen-to-neutrophil ratio for the diagnosis of prostate cancer

Discov Oncol. 2025 Jan 6;16(1):13. doi: 10.1007/s12672-025-01760-8.

Authors

Yuxuan Chen^#¹, Haisheng Yan^#², Yaoqin Xu^#², Kexin Chen^#², Runqin Yang², Jiali Yang¹, Ruian Zhu³, Rui Lin⁴, Jiang Wang⁴, Jie Liu⁵, Pingsheng Gao⁶, Lei Pang⁷, Lexin Wang⁸

Affiliations

¹ Department of Urology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750004, Ningxia, China.
² Ningxia Medical University, Yinchuan, 750000, Ningxia, China.
³ Western Institute of Digital-Intelligent Medicine, Chongqing, 401329, China.
⁴ School of Clinical Medicine, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China.
⁵ Department of General Surgery, Dazhou Central Hospital, Dazhou, 635000, China.
⁶ Department of Urology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750004, Ningxia, China. gaopingsheng2009@163.com.
⁷ Department of Clinical Research Center, Dazhou Central Hospital, Dazhou, 635000, Sichuan, China. pangleimn@163.com.
⁸ Department of Urology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750004, Ningxia, China. 1418801292@qq.com.

^# Contributed equally.

Abstract

Background: Currently, serum PSA is the most commonly used screening tool in clinical practice. However, PSA levels in the range of 4-10 ng/ml are considered the 'grey zone' of prostate cancer screening. Patients within this range need to be further evaluated using additional parameters such as PSA ratio, PSA density, and other indices to determine the necessity of prostate biopsy (PBx). Despite this, patients in the 'grey zone' still have a low rate of positive biopsy results. Neutrophils have been found to be associated with tumor development and inflammation. Based on this, we combined PSA and absolute neutrophil counts to calculate the total PSA to absolute neutrophil ratio (PNR), which is higher in patients with prostate cancer and lower in those with benign conditions. PNR is elevated in prostate cancer patients compared to those with prostate enlargement. Therefore, the aim of this study is to explore the diagnostic efficacy of PNR for prostate cancer across different PSA intervals and to provide new insights into the diagnosis, treatment, and screening strategies for prostate cancer.

Objective: In this study, we explored the predictive value of prostate-specific antigen-to-neutrophil ratio (PNR) for the diagnosis of prostate cancer, with a view to further improving the diagnostic accuracy of prostate cancer.

Methods: Patients were grouped in three different divisions of PSA 4-10 ng/ml, 10-20 ng/ml, > 20 ng/ml, We grouped the patients and compared the test data such as age, PSA, PSA-density (PSAD), and prostate-specific antigen-to-neutrophil ratio (PNR) between the two groups of patients who had puncture results of prostate cancer and non-prostate cancer at the same time using Log regression test to verify the diagnostic value of PNR.

Results: When PSA levels are in the range of 4-10 ng/ml, an elevated PNR is an independent risk factor for prostate cancer. In this range, the diagnostic value of f/t PSA and PSAD for prostate cancer is limited. However, the use of PNR can significantly enhance the diagnostic efficacy for prostate cancer and thereby effectively reduce the incidence of unnecessary prostate biopsies.

Keywords: Neut; PNR; PSA; Prostate cancer; Prostate puncture biopsy.