# AMACR and ZFPL1 serum biomarkers enhance precision in predicting postoperative prostate cancer outcomes

## TL;DR

This study shows that measuring AMACR and ZFPL1 in blood can improve predictions of prostate cancer recurrence after surgery.

## Contribution

The study introduces AMACR and ZFPL1 as novel serum biomarkers for predicting prostate cancer recurrence and develops a predictive nomogram integrating these markers.

## Key findings

- Elevated AMACR and ZFPL1 levels independently predict recurrence after prostatectomy.
- A nomogram combining these biomarkers with clinicopathological factors shows strong predictive accuracy.
- The model's performance remains stable up to 3 years post-surgery.

## Abstract

Prostate cancer (PCa) remains a major clinical challenge, with postoperative recurrence risk varying substantially among patients. Emerging evidence suggests that serum biomarkers, including α-methylacyl-CoA racemase (AMACR) and zinc finger protein-like 1 (ZFPL1), may provide additional prognostic information beyond conventional clinicopathological factors.

This single-center retrospective study included 115 patients with PCa who underwent radical prostatectomy. Serum AMACR and ZFPL1 levels were analyzed in combination with clinicopathological variables. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of recurrence. A risk nomogram was constructed, and model performance was evaluated using receiver operating characteristic (ROC) curve analysis and Kaplan–Meier survival analysis.

Poor postoperative outcomes were significantly associated with advanced age, lymph node metastasis, higher TNM stage, poor tumor differentiation, and higher Gleason score. Serum AMACR and ZFPL1 levels were significantly elevated in patients who experienced recurrence. Multivariate analysis identified both biomarkers as independent predictors of recurrence. The resulting nomogram demonstrated strong discriminative performance and stable predictive accuracy across multiple postoperative time points.

Elevated serum AMACR and ZFPL1 levels independently predict recurrence following radical prostatectomy in patients with PCa. The proposed nomogram integrates molecular and clinicopathological factors to provide accurate postoperative risk stratification, supporting individualized follow-up and management, with robust performance observed up to 3 years after surgery.

The molecular mechanism by which AMACR and ZFPL1 regulate postoperative recurrence in PCa.Diagram illustrating metabolic reprogramming and Golgi apparatus function in cancer. It shows tumor cells with fatty acid uptake mediated by CD36, AMACR's conversion role, and mitochondrial beta oxidation. It includes PI3K and Akt phosphorylation effects, ZFPL1 secretion, and its complex with EZH2 affecting chromatin modification. Additionally, it highlights Golgi apparatus's role in secreting MMPs and VEGF, leading to tumor suppressor gene silencing. A section illustrates the proximity of a tumor to the bladder and prostate.

The molecular mechanism by which AMACR and ZFPL1 regulate postoperative recurrence in PCa.