Department of Urology and Division of Medical Oncology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
Acta Oncol. 2011 Jun;50 Suppl 1(Suppl 1):61-75. doi: 10.3109/0284186X.2010.542174.
The introduction of total prostate specific antigen (total PSA) testing in blood has revolutionized the detection and management of men with prostate cancer (PCa). The objective of this review was to discuss the challenges of PCa biomarker research, definition of the type of PCa biomarkers, the statistical considerations for biomarker discovery and validation, and to review the literature regarding total PSA velocity and novel blood-based biomarkers.
An English-language literature review of the Medline database (1990 to August 2010) of published data on blood-based biomarkers and PCa was undertaken.
The inherent biological variability of total PSA levels affects the interpretation of any single result. Men who will eventually develop PCa have increased total PSA levels years or decades before the cancer is diagnosed. Total PSA velocity improves predictiveness of total PSA only marginally, limiting its value for PCa screening and prognostication. The combination of PSA molecular forms and other biomarkers improve PCa detection substantially. Several novel blood-based biomarkers such as human glandular kallikrein 2 (hK2), urokinase plasminogen activator (uPA) and its receptor (uPAR), transforming growth factor-beta 1 (TGF-β1); interleukin-6 (IL-6) and its receptor (IL-6R) may help PCa diagnosis, staging, prognostication, and monitoring. Panels of biomarkers that capture the biologic potential of PCa are in the process of being validated for PCa prognostication.
PSA is a strong prognostic marker for long-term risk of clinically relevant cancer. However, there is a need for novel biomarkers that aid clinical decision making about biopsy and initial treatment. There is no doubt that progress will continue based on the integrated collaboration of researchers, clinicians and biomedical firms.
总前列腺特异性抗原（总 PSA）检测在血液中的引入彻底改变了前列腺癌（PCa）的检测和管理方式。本综述的目的是讨论 PCa 生物标志物研究的挑战、PCa 生物标志物的定义类型、生物标志物发现和验证的统计学考虑，并回顾关于总 PSA 速度和新型基于血液的生物标志物的文献。
对 Medline 数据库（1990 年至 2010 年 8 月）中有关基于血液的生物标志物和 PCa 的已发表数据进行了英语文献综述。
总 PSA 水平的固有生物学变异性影响对任何单一结果的解释。最终会发展为 PCa 的男性在癌症诊断前数年或数十年内总 PSA 水平升高。总 PSA 速度仅略微提高了总 PSA 的预测能力，限制了其在 PCa 筛查和预后中的价值。PSA 分子形式和其他生物标志物的组合可大大提高 PCa 的检测能力。几种新型基于血液的生物标志物，如人组织激肽释放酶 2（hK2）、尿激酶纤溶酶原激活物（uPA）及其受体（uPAR）、转化生长因子-β1（TGF-β1）；白细胞介素-6（IL-6）及其受体（IL-6R）可能有助于 PCa 的诊断、分期、预后和监测。正在验证用于 PCa 预后的生物标志物组合。
PSA 是预测长期发生临床相关癌症风险的强有力的预后标志物。然而，需要新的生物标志物来辅助关于活检和初始治疗的临床决策。毫无疑问，基于研究人员、临床医生和生物医学公司的综合协作，将继续取得进展。
