Fleshner Neil E, Lawrentschuk Nathan
Division of Urology, University Health Network, Toronto, Ontario, Canada.
Urology. 2009 May;73(5 Suppl):S21-7. doi: 10.1016/j.urology.2009.02.022.
In many disease states, the use of biomarkers is a standard method of determining both the presence and the risk of the future development of disease. For several years, total prostate-specific antigen (PSA) levels have been the standard measure for the diagnosis of prostate cancer (PCa) and other prostatic diseases. However, recent data have indicated that PSA can also be used to determine the risk of developing PCa in the future. This evolving use of PSA is supported by clinical trial data from the Baltimore Longitudinal Study of Aging, the European Randomized Study of Screening for Prostate Cancer, and the Malmö Preventive Medicine Study. Data from the European Randomized Study of Screening for Prostate Cancer have demonstrated that men with a PSA level of > or =1.5 ng/mL are at a significantly elevated risk of developing PCa compared with patients with a PSA level <1.5 ng/mL. The Malmö study showed that the PSA level could independently the predict cancer risk as far as 25-30 years into the future. Secondary nonserum risk factors (eg, age, family history, ethnicity) can also offer predictive value for determining the risk of developing future disease. Furthermore, recent investigations of novel biomarkers have yielded promising PCa prognostic candidates, including the PCa gene 3 and early PCa antigen 2. However, PSA remains the most reliable measure in assessing the risk of developing PCa.
在许多疾病状态下，使用生物标志物是确定疾病是否存在以及未来发生风险的标准方法。多年来，总前列腺特异性抗原（PSA）水平一直是诊断前列腺癌（PCa）和其他前列腺疾病的标准指标。然而，最近的数据表明，PSA还可用于确定未来发生PCa的风险。来自巴尔的摩纵向衰老研究、欧洲前列腺癌筛查随机研究以及马尔默预防医学研究的临床试验数据支持了PSA这种不断演变的用途。欧洲前列腺癌筛查随机研究的数据表明，与PSA水平<1.5 ng/mL的患者相比，PSA水平≥1.5 ng/mL的男性发生PCa的风险显著升高。马尔默研究表明，PSA水平能够独立预测长达25至30年的癌症风险。次要的非血清风险因素（如年龄、家族史、种族）也可为确定未来发生疾病的风险提供预测价值。此外，最近对新型生物标志物的研究已经产生了有前景的PCa预后候选指标，包括前列腺癌基因3和早期前列腺癌抗原2。然而，PSA仍然是评估发生PCa风险最可靠的指标。
