Department of Urology, Medical University of Graz, Graz, Austria.
Eur Urol. 2011 Nov;60(5):1045-54. doi: 10.1016/j.eururo.2011.08.003. Epub 2011 Aug 25.
Newly discovered biomarkers ideally should prove clinical usefulness, provide additional detection, staging, and prognosis information to improve individual risk assessment, and potentially permit targeted cancer therapy.
To review, display, and evaluate the current evidence regarding the biologic and analytic approach of urinary prostate cancer gene 3 (PCA3) in prostate cancer (PCa) detection, staging, and prognosis, and its therapeutic potential.
A systematic and comprehensive Medline search was performed using the Medical Subject Headings search terms PCA3, DD3, UPM3, prostate cancer, cell-lines, prostate tissue, prostate biopsy, detection, diagnosis, radical prostatectomy, staging, grading, progression, and gene therapy. Results were restricted to English-language papers published within the period 1999-2011.
The PCA3 gene is highly overexpressed in specific PCa cell lines and prostatic tumours. In 2006, a simple and robust urine test (Progensa) became commercially available. Despite its costs, prostate cancer antigen 3 (PCA3) is superior to prostate-specific antigen (PSA) and percent free PSA in the early detection of PCa. PCA3 improves the diagnostic accuracy of externally validated nomograms among men with an elevated PSA undergoing biopsy. PCA3 independently predicts low-volume disease and pathologically insignificant PCa but is not associated with locally advanced disease and is limited in the prediction of aggressive cancer. Preliminary data demonstrate that combining PCA3 with other new biomarkers further improves diagnostic and prognostic accuracy. Finally, findings of the first PCA3-Gene-ViroTherapy study suggest therapeutic potential by exploiting PCA3 overexpression.
PCA3, integrated in novel biopsy nomograms or risk stratification tools, can be used to counsel or confirm biopsy indications. If confirmed in further studies, using PCA3 together with established staging risk factors could assist clinicians in specific pretreatment decision making. So far no evidence for the usefulness of PCA3 in active surveillance programs has been presented.
新发现的生物标志物理想情况下应证明具有临床实用性，提供额外的检测、分期和预后信息，以改善个体风险评估，并可能允许针对癌症的靶向治疗。
回顾、展示和评估尿前列腺癌基因 3（PCA3）在前列腺癌（PCa）检测、分期和预后中的生物学和分析方法及其治疗潜力的当前证据。
使用主题词搜索“PCA3、DD3、UPM3、前列腺癌、细胞系、前列腺组织、前列腺活检、检测、诊断、根治性前列腺切除术、分期、分级、进展和基因治疗”，对 Medline 进行了系统和全面的检索。结果仅限于在 1999 年至 2011 年期间发表的英文论文。
PCA3 基因在特定的 PCa 细胞系和前列腺肿瘤中高度过表达。2006 年，一种简单而强大的尿液检测（Progensa）开始商业化。尽管价格昂贵，但前列腺癌抗原 3（PCA3）在 PCa 的早期检测中优于前列腺特异性抗原（PSA）和游离 PSA 百分比。在接受活检的 PSA 升高的男性中，PCA3 可提高经外部验证的列线图的诊断准确性。PCA3 独立预测低体积疾病和病理意义不大的 PCa，但与局部晚期疾病无关，并且在预测侵袭性癌症方面受到限制。初步数据表明，将 PCA3 与其他新的生物标志物结合使用可进一步提高诊断和预后准确性。最后，首次 PCA3-Gene-ViroTherapy 研究的结果表明，通过利用 PCA3 的过表达具有治疗潜力。
PCA3 可整合到新的活检列线图或风险分层工具中，用于提供咨询或确认活检指征。如果在进一步的研究中得到证实，使用 PCA3 与既定的分期危险因素一起可以帮助临床医生在特定的治疗前决策中做出决策。迄今为止，尚无证据表明 PCA3 在主动监测计划中的有用性。
