Aim: Prostate cancer is the second major cause of cancer-related deaths in men. Digital rectal examination, serum PSA and biopsy are the main tools used in the diagnosis of prostate cancer. The low specificity of PSA leads to unnecessary biopsies. Therefore, biomarkers with high specificity are needed. There are studies on the role of sarcosine in the diagnosis of PCa. However, results aren’t comparable due to differences in study designs. We aimed to compare the performance of the urine sarcosine level, pro-PSA with existing biomarkers in the study.

Materials and Methods: A total of 105 patients were included in the study. The PSA, fPSA , %fPSA, p2PSA, prostate volume, phi, and urinary sarcosine levels were compared. Diagnostic performances were evaluated by ROC analyses and their cut-off values, sensitivity, and specificity were compared. In addition, PCa patients were divided into two groups according to their Gleason scores (<7 and ≥7) and the distributions of these parameters were examined.

Results: Serum PSA, p2PSA, and urinary sarcosine levels were not statistically different although they were higher in the biopsy-positive group. However, the phi value was significantly higher in the biopsy-positive group, and the % fPSA and PV values were lower. Sarcosine and PSA were significantly higher in the GS≥7 group. At cut-off values where the sensitivity of the markers was 90%, the specificities of %fPSA, PV, and phi were higher than PSA, respectively.

Conclusion: It was determined that urinary sarcosine alone was not sufficient for the diagnosis of PCa, but it may be used in risky PCa patients with GS ≥ 7. Phi, fPSA%, and PV were found to be better than PSA in the diagnosis of PCa. In addition, it was determined that adding PV to the parameters used in phi would improve the specificity.