Department of Urology, Pathology and Biochemistry, CHU Henri Mondor, APHP, Créteil, France.
Eur Urol. 2011 Mar;59(3):422-9. doi: 10.1016/j.eururo.2010.11.044. Epub 2010 Dec 8.
The optimal selection of prostate cancer (PCa) patients for active surveillance (AS) is currently being debated.
To assess the impact of urinary prostate cancer antigen 3 (PCA3) score as an AS criterion instead of and in addition to the current criteria.
DESIGN, SETTING, AND PARTICIPANTS: We prospectively studied 106 consecutive low-risk PCa patients (prostate-specific antigen [PSA] ≤10 ng/ml, clinical stage T1c-T2a, and biopsy Gleason score 6) who underwent a PCA3 urine test before radical prostatectomy (RP).
Performance of AS criteria (biopsy criteria, PCA3 score, PSA density, and magnetic resonance imaging [MRI] findings) was tested in predicting four prognostic pathologic findings in RP specimens: (1) pT3-4 disease; (2) overall unfavourable disease (OUD) defined by pT3-4 disease and/or pathologic primary Gleason pattern 4; (3) tumour volume <0.5 cm(3); and (4) insignificant PCa.
The PCA3 score was strongly correlated with the tumour volume in a linear regression analysis (p<0.001, r=0.409). The risk of having a cancer ≥0.5 cm(3) and a significant PCa was increased three-fold in men with a PCA3 score of ≥25 compared with men with a PCA3 score of <25 with most AS biopsy criteria used. There was a trend towards higher PCA3 scores in patients with unfavourable and non-organ-confined disease and Gleason >6 cancers. In a multivariate analysis taking into account each AS criterion, a high PCA3 score (≥25) was an important predictive factor for tumour volume ≥0.5 cm(3) (odds ratio [OR]: 5.4; p=0.010) and significant PCa (OR: 12.7; p=0.003). Biopsy criteria and MRI findings were significantly associated with OUD (OR: 3.9 and 5.0, respectively; p=0.030 and p=0.025, respectively).
PCA3 score may be a useful marker to improve the selection for AS in addition to the current AS criteria. With a predictive cut-off of 25, PCA3 score is strongly indicative for tumour volume and insignificant PCa.
目前，对于前列腺癌（PCa）患者进行主动监测（AS）的最佳选择仍存在争议。
评估尿前列腺癌抗原 3（PCA3）评分作为 AS 标准的作用，包括替代和补充当前标准。
设计、地点和参与者：我们前瞻性研究了 106 例连续的低危 PCa 患者（前列腺特异性抗原[PSA]≤10ng/ml，临床分期 T1c-T2a，和活检 Gleason 评分 6），这些患者在根治性前列腺切除术（RP）前进行了 PCA3 尿液检测。
在 RP 标本中检测 AS 标准（活检标准、PCA3 评分、PSA 密度和磁共振成像[MRI]发现）预测四种预后病理发现的性能：（1）pT3-4 疾病；（2）定义为 pT3-4 疾病和/或原发性 Gleason 模式 4 的总不利疾病（OUD）；（3）肿瘤体积<0.5cm3；和（4）非显著 PCa。
PCA3 评分与线性回归分析中的肿瘤体积呈强相关性（p<0.001，r=0.409）。与 PCA3 评分<25 的患者相比，PCA3 评分≥25 的患者患≥0.5cm3 癌症和显著 PCa 的风险增加了两倍，大多数 AS 活检标准都适用。在考虑到每个 AS 标准的多变量分析中，高 PCA3 评分（≥25）是肿瘤体积≥0.5cm3（优势比[OR]：5.4；p=0.010）和显著 PCa（OR：12.7；p=0.003）的重要预测因素。活检标准和 MRI 发现与 OUD 显著相关（OR：3.9 和 5.0，分别；p=0.030 和 p=0.025）。
PCA3 评分可能是除当前 AS 标准外，用于 AS 选择的有用标志物。当预测截止值为 25 时，PCA3 评分强烈提示肿瘤体积和非显著 PCa。
