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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter

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Volume 53, Issue 3


Urinary thiosulfate as failed prostate cancer biomarker – an exemplary multicenter re-evaluation study

Carsten Stephan
  • Department of Urology, University Hospital Charité and Berlin Institute for Urologic Research, Berlin, Germany
  • Other articles by this author:
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/ Jacek Wilkosz / Waldemar Różański / Thorsten H. Ecke / Michael Lein
  • Department of Urology, Sana Hospital Center and University Teaching Hospital, Offenbach, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Magdalena Bryś / Anna Krześlak / Grażyna Chwatko
  • Department of Environmental Chemistry, Faculty of Chemistry, University of Łódź, Łódź, Poland
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Klaus Jung
  • Corresponding author
  • Department of Urology, University Hospital Charité and Berlin Institute for Urologic Research, Berlin, Germany
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2014-09-30 | DOI: https://doi.org/10.1515/cclm-2014-0729


Background: In 2013, thiosulfate in urine has been proposed as promising prostate cancer (PCa) biomarker. However, a missing comparison with other proven PCa markers suggested a re-evaluation study. Therefore, together with the authors from the initial study, the diagnostic accuracy of thiosulfate was compared with that of urinary prostate cancer associated 3 (PCA3), serum prostate health index (Phi), and percent free prostate-specific antigen (%fPSA). Thiosulfate was further measured in a multicenter approach to exclude center-related biases.

Methods: Thiosulfate, calculated as ratio of thiosulfate to urinary creatinine (TS/Crea ratio), was measured in two cohorts in a total of 269 patients. In the retrospective study (n=160) PCA3, Phi, PSA, and %fPSA were compared with the TS/Crea ratio between patients with and without PCa according to the prostate needle biopsy results. The second prospective cohort included 109 patients from four centers.

Results: The median TS/Crea ratio was not statistically different between the patients with and without PCa. The receiver-operating characteristics showed that the TS/Crea ratio was unable to discriminate between patients with and without PCa in contrast to %fPSA, Phi, and PCA3. In all four centers, the low median TS/Crea ratios (<1 mmol/mol) in both patient cohorts were confirmed and thiosulfate was again not able to distinguish between them (p-values, 0.13–0.90).

Conclusions: This study could not confirm the previously observed high median TS/Crea ratio in PCa patients in comparison to non-PCa patients. Thiosulfate subsequently failed as PCa biomarker while PCA3 and Phi showed the expected diagnostic improvement.

Keywords: biomarker; PCA3; Phi; prostate cancer; prostate- specific antigen; thiosulfate


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About the article

Corresponding author: Klaus Jung, Department of Urology, University Hospital Charité and Berlin Institute for Urologic Research, Schumannstrasse 20/21, 10117 Berlin, Germany, Phone: +49 30 450 515041, E-mail:

aCarsten Stephan, Jacek Wilkosz, Waldemar Różański, Grażyna Chwatko and Klaus Jung shared first and senior authorship, respectively.

Received: 2014-07-15

Accepted: 2014-09-02

Published Online: 2014-09-30

Published in Print: 2015-02-01

Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 53, Issue 3, Pages 477–483, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2014-0729.

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