The γ-
interferon-induced
enzymes indoleamine 2,3-dioxygenase and
GTP-cyclohydrolase are key players in tumor immune escape mechanisms. We quantified serum levels of
neopterin and
tryptophan breakdown (
tryptophan,
kynurenine, and
kynurenine-to-
tryptophan ratio) in addition to
prostate-specific antigen (PSA) in newly diagnosed
prostate cancer (PCa) patients (n = 100) before radical
prostatectomy (RP) as well as at time of biochemical recurrence (BCR) after RP (n = 50) in comparison to healthy men (n = 49). Effects of
biomarkers on the risk of PCa diagnosis on transrectal biopsy, worse histopathological characteristics of the RP specimens, and
cancer-specific survival (CSS) after BCR were investigated.
Neopterin (hazard ratio [HR], 2.46; 95% confidence interval [CI], 1.08-5.61; P = 0.032) and
kynurenine (HR, 2.93; 95% CI, 1.26-6.79; P = 0.012) levels were univariately associated with CSS. When adjusted for other
biomarkers, only
neopterin remained an independent predictor of CSS (HR, 2.56; 95% CI, 1.07-6.12; P = 0.035). Only PSA was associated with an increased risk of PCa diagnosis on biopsy, univariately (odds ratio, 3.14; 95% CI, 1.68-5.88; P < 0.001) as well when adjusted for other
biomarkers (odds ratio, 3.29; 95% CI, 1.70-6.35; P < 0.001). Moreover, only preoperative PSA was able to predict
positive surgical margin (area under the receiver operating characteristic curve [AUC] = 0.71; 95% CI, 0.59-0.82; P = 0.001), higher Gleason score (AUC = 0.75; 95% CI, 0.66-0.85; P < 0.001) and extraprostatic involvement (AUC = 0.79; 95% CI, 0.69-0.88; P < 0.001) at RP specimens, respectively. Although serum
neopterin and
tryptophan breakdown cannot be considered as
biomarkers in detecting PCa or in predicting worse final pathological findings,
neopterin levels are useful for stratifying patients into different prognostic groups after BCR.