Erasmus University Medical Centre, Rotterdam, The Netherlands.
Curr Opin Urol. 2011 May;21(3):225-9. doi: 10.1097/MOU.0b013e328344939c.
With increasing evidence that prostate-specific antigen (PSA)-based screening can reduce disease-specific mortality but coincides with unacceptable levels of unnecessary testing and the diagnosis of potentially nonlife-threatening disease, the need for new, more specific biomarkers is urgent. Within this context the role of the prostate cancer gene 3 (PCA3) test is evaluated.
Studies investigating the value of PCA3 as a diagnostic test virtually all show a beneficial effect as compared to PSA with respect to specificity. Beside the fact that most of these studies are subject to potential bias, the observed increased specificity was accompanied by relatively low sensitivities. Two studies, attempting to avoid selection bias as much as possible, show a marginal beneficial effect of the PCA3 test. Data on PCA3 as a staging tool for prostate cancer remain inconclusive.
The PCA3 test is not capable of replacing the PSA test in clinical practice and an appropriate cut-off level with acceptable performance characteristics is hard to define. Its value as a first-line diagnostic test is limited. The addition of PCA3 to risk assessment tools leads to an increase in predictive capability. Data relating to the accuracy of PCA3 on prostate cancer staging are contradictory and PCA3 as prognostic test should be subject of future studies.
越来越多的证据表明，基于前列腺特异性抗原（PSA）的筛查可以降低疾病特异性死亡率，但同时也伴随着不可接受的过度检测水平和潜在非威胁生命疾病的诊断，因此迫切需要新的、更具特异性的生物标志物。在此背景下，评估了前列腺癌基因 3（PCA3）检测的作用。
几乎所有研究 PCA3 作为诊断检测的价值的研究都显示出与 PSA 相比具有更高的特异性。除了这些研究大多存在潜在偏倚这一事实外，观察到的特异性增加伴随着相对较低的敏感性。两项试图尽可能避免选择偏倚的研究显示 PCA3 检测具有边缘有益的效果。关于 PCA3 作为前列腺癌分期工具的数据仍不确定。
PCA3 检测不能替代 PSA 检测在临床实践中的应用，难以定义具有可接受性能特征的适当截断值。它作为一线诊断检测的价值有限。PCA3 增加到风险评估工具中可提高预测能力。关于 PCA3 对前列腺癌分期准确性的数据相互矛盾，PCA3 作为预后检测应成为未来研究的课题。
