Raaijmakers René, de Vries Stijn H, Blijenberg Bert G, Wildhagen Mark F, Postma Renske, Bangma Chris H, Darte Claude, Schröder Fritz H
Department of Urology, Erasmus MC, Rotterdam, The Netherlands.
Eur Urol. 2007 Nov;52(5):1358-64. doi: 10.1016/j.eururo.2007.04.037. Epub 2007 Apr 20.
The purpose of screening for prostate cancer is to decrease the disease-specific mortality. However not every screen-detected prostate cancer is a threat to the patient's life. The risk of overdetection and subsequent overtreatment in prostate cancer has been recognised. The purpose of this investigation was to evaluate the role of tumour markers total PSA, free PSA, and hK2, and their combinations in predicting minimal prostate cancer.
Within the European Randomized Study of Screening for Prostate Cancer (ERSPC), section Rotterdam, The Netherlands, prebiopsy serum samples were analysed for 100 selected men who underwent a radical prostatectomy for their screen-detected prostate cancer. All had a PSA value between 4 and 10 ng/ml prior to diagnosis. Minimal prostate cancer is defined as organ confined, Gleason score </=6 (no Gleason grade 4 or 5), and tumour volume <0.5 ml.
Sera and tumour volumes from 91 men were available for analysis. Minimal prostate cancer was diagnosed in 16.5% of the selected cases. Mean tumour volume was 1.2 ml (range: 0.04-13.5); hK2, the algorithms hK2/fPSA, and hK2/%fPSA have significant correlations with tumour volume. Both algorithms also yielded the best test results in predicting minimal disease with an area under the receiver operator characteristics curve of 82%.
hK2 and percent free PSA have added prognostic value for the detection of minimal prostate cancer in screen-detected cases within PSA range 4-10 ng/ml. These biomarkers can possibly be used to select less invasive treatment options like active surveillance and to prevent overtreatment.
前列腺癌筛查的目的是降低疾病特异性死亡率。然而，并非所有筛查发现的前列腺癌都对患者生命构成威胁。前列腺癌过度检测及后续过度治疗的风险已得到认可。本研究的目的是评估肿瘤标志物总前列腺特异性抗原（total PSA）、游离前列腺特异性抗原（free PSA）和人激肽释放酶2（hK2）及其组合在预测微小前列腺癌中的作用。
在欧洲前列腺癌筛查随机研究（ERSPC）荷兰鹿特丹分部中，对100名因筛查发现的前列腺癌而接受根治性前列腺切除术的男性患者，在活检前分析其血清样本。所有患者在诊断前的PSA值均在4至10 ng/ml之间。微小前列腺癌定义为局限于器官内、Gleason评分≤6（无Gleason 4级或5级）且肿瘤体积<0.5 ml。
91名男性的血清和肿瘤体积可供分析。在所选病例中，16.5%被诊断为微小前列腺癌。平均肿瘤体积为1.2 ml（范围：0.04 - 13.5）；hK2、hK2/fPSA算法和hK2/%fPSA与肿瘤体积有显著相关性。两种算法在预测微小疾病方面也产生了最佳测试结果，受试者操作特征曲线下面积为82%。
对于PSA范围在4 - 10 ng/ml的筛查发现病例，hK2和游离PSA百分比对微小前列腺癌的检测具有额外的预后价值。这些生物标志物可能可用于选择如主动监测等侵入性较小的治疗方案，并防止过度治疗。
