Comparing Diagnostic Value of Serum Histone Deacetylase 1, Prostate Specific Antigen (PSA) and PSA Density in Differentiating Prostate Cancer from Benign Prostatic Hyperplasia: A Cross-sectional Study

Introduction: Prostate Cancer (PCa) and Benign Prostatic Hyperplasia (BPH) often present with overlapping clinical symptoms, complicating accurate diagnosis. Although ProstateSpecific Antigen (PSA) and PSA Density (PSAD) are widely used diagnostic tools, their limited specificity underscores the need for novel biomarkers. Histone Deacetylase 1 (HDAC1), an epigenetic regulator implicated in tumour progression, may serve as a non-invasive biomarker for PCa detection and risk stratification. Aim: To compare the diagnostic value of serum HDAC1, PSA, and PSAD in differentiating PCa from BPH, and to assess their association with the Gleason score. Materials and Methods: The present study was conducted at KAHER’s Jawaharlal Nehru Medical College and KLE Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi, Karnataka, India, from December 2022 to November 2024. A total of 130 male patients aged over 40 years were included, comprising 65 patients with PCa and 65 with BPH. Serum HDAC1 levels were quantified using a high-sensitivity EnzymeLinked Immunosorbent Assay (ELISA). The correlation between serum HDAC1 levels and the Gleason score was assessed using Spearman’s rank correlation coefficient (ρ). Multivariate logistic regression analysis was performed to identify independent predictors of PCa. Data analysis was conducted using the Mann-Whitney U test, Receiver Operating Characteristic (ROC) analysis, logistic regression, and Spearman correlation, using the Statistical Package for the Social Sciences (SPSS) version 25.0. Results: Serum HDAC1 levels were significantly elevated in patients with PCa compared with those with BPH (p<0.001). Compared with PSA (AUC=0.789) and PSAD (AUC=0.697), HDAC1 demonstrated superior diagnostic performance (AUC=0.922). Multivariate logistic regression analysis identified HDAC1 as an independent predictor of PCa (Odds Ratio (OR)=6.624, p<0.001). HDAC1 also showed a strong positive correlation with the Gleason score (ρ=0.649, p<0.001). ROC analysis further confirmed the ability of HDAC1 to distinguish high-grade (Gleason ≥7) from low-grade (≤6) PCa (AUC=0.803). Conclusion: Serum HDAC1 is a promising non-invasive biomarker with high sensitivity and specificity for distinguishing PCa from BPH and predicting tumour aggressiveness. Its integration into clinical diagnostic algorithms may enhance early detection and reduce reliance on invasive procedures.