Samaratunga Hemamali, Epstein Jonathan I
Department of Anatomical Pathology, Sullivan Nicolaides Pathology, 134 Whitmore Street, Taringa, Brisbane, QLD, 4068, Australia.
World J Urol. 2008 Oct;26(5):431-6. doi: 10.1007/s00345-008-0260-5. Epub 2008 Apr 12.
Low-risk prostate cancer is defined as a clinical T1c or T2a tumor with a Gleason score of </=6 and PSA <10 ng/ml. This is a pretreatment diagnosis and the patient can turn out to have either significant or insignificant disease. With methods currently available in practice it may not be possible to differentiate between these groups. Numerous molecular pathological changes have been described in prostate carcinoma. This review was to evaluate which of these changes may be useful to distinguish the group of patients likely to have significant carcinoma within the low risk category.
The literature on molecular pathology of prostate cancer was reviewed using MEDLINE and reference lists of relevant publications focusing on early and late molecular events and available molecular biomarkers in prostate cancer.
There are a variety of molecular markers with the potential to be clinically utilized for assessment of low risk prostate cancer. One of the most promising is TMPRSS2: ETS fusion, which is a homogeneous event occurring early in prostate carcinogenesis. Other promising markers include p27, EZH2 and c-MYC.
FISH analysis or RT-PCR based assays to detect TMPRSS2: ETS fusion and immunohistochemical assessment of p27, EZH2 and c-MYC may become useful ancillary tests in patients with low risk prostate cancer. Some serum biomarkers have promise for future use. Large prospective studies followed by clinical trials are necessary before these molecular markers could be integrated into clinical practice.
低风险前列腺癌被定义为临床T1c或T2a期肿瘤，Gleason评分≤6且前列腺特异性抗原（PSA）<10 ng/ml。这是一种治疗前诊断，患者最终可能患有显著或不显著的疾病。使用目前实践中可用的方法可能无法区分这些组。前列腺癌中已描述了许多分子病理学变化。本综述旨在评估这些变化中哪些可能有助于区分低风险类别中可能患有显著癌的患者组。
使用医学文献数据库（MEDLINE）以及相关出版物的参考文献列表，对前列腺癌分子病理学的文献进行综述，重点关注前列腺癌的早期和晚期分子事件以及可用的分子生物标志物。
有多种分子标志物有潜力在临床上用于评估低风险前列腺癌。最有前景的标志物之一是跨膜丝氨酸蛋白酶2（TMPRSS2）：ETS融合，这是前列腺癌发生早期出现的一种均一事件。其他有前景的标志物包括p27、EZH2和c-MYC。
检测TMPRSS2：ETS融合的荧光原位杂交（FISH）分析或基于逆转录聚合酶链反应（RT-PCR）的检测方法，以及对p27、EZH2和c-MYC的免疫组化评估，可能成为低风险前列腺癌患者有用的辅助检测。一些血清生物标志物有望在未来得到应用。在这些分子标志物能够整合到临床实践之前，有必要进行大规模的前瞻性研究，随后开展临床试验。
