前列腺癌抗原 3 评分能准确预测肿瘤体积，有助于选择适合主动监测的前列腺癌患者。

Prostate cancer antigen 3 score accurately predicts tumour volume and might help in selecting prostate cancer patients for active surveillance.

机构信息

Department of Urology, Pathology and Biochemistry, CHU Henri Mondor, APHP, Créteil, France.

出版信息

Eur Urol. 2011 Mar;59(3):422-9. doi: 10.1016/j.eururo.2010.11.044. Epub 2010 Dec 8.

DOI:10.1016/j.eururo.2010.11.044

PMID:21156337

Abstract

BACKGROUND

The optimal selection of prostate cancer (PCa) patients for active surveillance (AS) is currently being debated.

OBJECTIVE

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).

MEASUREMENTS

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.

RESULTS AND LIMITATIONS

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).

CONCLUSIONS

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.

摘要

背景

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。

目的

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。

测量

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。

结果和局限性

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）。