Volume 58, Issue 1, Pages 12-18 (July 2010) Sarcosine in Urine after Digital Rectal Examination Fails as a Marker in Prostate Cancer Detection and Identification of Aggressive Tumours  Florian Jentzmik, Carsten Stephan, Kurt Miller, Mark Schrader, Andreas Erbersdobler, Glen Kristiansen, Michael Lein, Klaus Jung  European Urology  Volume 58, Issue 1, Pages 12-18 (July 2010) DOI: 10.1016/j.eururo.2010.01.035 Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 1 Sarcosine-creatinine ratio in urine of patients with prostate cancer (PCa) and with no evidence of malignancy (NEM) after digital rectal examination and in healthy females (HF) and males (HM). (A) Sarcosine in urine of the study groups. Differences between the NEM and PCa patients and between healthy females and males were tested by the Mann-Whitney U-test. (B) Sarcosine in urine of the PCa patients categorised according to the pathologic tumour stage pT2 and pT3. (C) Sarcosine in urine of the PCa patients categorised according to the biopsy-based Gleason scores <7 and ≥7. (D) Sarcosine in urine of the PCa patients categorised according to the prostatectomy-based Gleason scores <7 and ≥7. Differences between (B those categorised according to the pathologic tumour stage pT2 and pT3 and (C) those categorised according to the biopsy-based Gleason scores <7 and ≥7 were tested by the Mann-Whitney U test. European Urology 2010 58, 12-18DOI: (10.1016/j.eururo.2010.01.035) Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 2 Sarcosine-creatinine ratio in urine of patients with prostate cancer (PCa) and with no evidence of malignancy (NEM) after digital rectal examination in relation to (A) age, (B) serum prostate-specific antigen, (C) prostate volume, and (D) creatinine in urine. The Spearman rank correlation coefficients (rS) and the linear regression lines were separately calculated for NEM (blue circle and line) and PCa (orange circle and line) patients. Since there were no significant differences between NEM and PCa patients, only the combined rS for both groups is indicated. European Urology 2010 58, 12-18DOI: (10.1016/j.eururo.2010.01.035) Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 3 Sarcosine-creatinine ratio in urine before and after digital rectal examination of prostate cancer patients. Urine samples of 10 patients were measured before and after the standardised digital rectal examination procedure according to Deras et al. [11]. Differences were tested by the Wilcoxon matched-pairs test. European Urology 2010 58, 12-18DOI: (10.1016/j.eururo.2010.01.035) Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 4 Receiver operating characteristic curves for sarcosine in urine, total prostate-specific antigen (PSA), and percent ratio of free to total PSA (%fPSA) to differentiate between prostate cancer (PCa) patients and patients with no evidence of malignancy (NEM). (A) Patients with PSA concentrations <20 ng/ml (PCa, n=106; NEM, n=33) and (B) with PSA concentrations <10 ng/ml (PCa, n=71; NEM, n=28) were tested. Area under the curve (AUC) of %fPSA was significantly larger than that of sarcosine (p=0.012) and clearly different from that of the null hypothesis value of 0.5 (p<0.0001). The AUCs of PSA were not different from that of sarcosine (p=0.933 and p=0.370, respectively). European Urology 2010 58, 12-18DOI: (10.1016/j.eururo.2010.01.035) Copyright © 2010 European Association of Urology Terms and Conditions