UZ Gasthuisberg, Leuven, Belgium, Austria.
BJU Int. 2012 Feb;109(3):360-6. doi: 10.1111/j.1464-410X.2011.10377.x. Epub 2011 Aug 26.
To evaluate the relationship between Prostate CAncer gene 3 (PCA3) and prostate cancer significance.
Clinical data from two multi-centre European open-label, prospective studies evaluating the clinical utility of the PCA3 assay in guiding initial and repeat biopsy decisions were analysed. First-catch urine was collected after digital rectal examination (three strokes per lobe) and the PCA3 score was determined using the PROGENSA(®) PCA3 assay. Transrectal ultrasound-guided biopsy (≥8 cores) and radical prostatectomy (RP) specimens were analysed by the local pathologist. The relationship between biopsy and RP outcomes with the PCA3 score was assessed.
Of the 1009 men enrolled, 348 (34%) had a positive biopsy. The median and mean PCA3 scores were statistically significantly lower in men with biopsy Gleason score <7 vs ≥7, with clinical stage T1c vs T2a-T2c, T3a cancers, with ≤33% vs >33% positive biopsy cores and with 'biopsy indolent' vs 'biopsy significant' prostate cancer (indolent prostate cancer defined by biopsy Epstein criteria). In all, 175 men with a positive biopsy had a RP: median and mean PCA3 scores were statistically significantly lower in men with pathological Gleason score <7 vs ≥7, and with pathological stage T2a-T2c vs T3a-T3b cancers.
The PCA3 score may combined with traditional tools aid in identifying men with clinically insignificant prostate cancer, as shown by biopsy and RP pathological features including biopsy Epstein criteria, who could be candidates for active surveillance. Treatment selection should be based on a combination of clinical and pathological variables. If one wants to use a threshold point to guide treatment decisions in clinical practice, a PCA3 score threshold of 20 may have the highest utility for selecting men with clinically insignificant prostate cancer in whom active surveillance may be appropriate; a PCA3 score threshold of 50 may be used to identify men at high risk of harbouring significant prostate cancer who are candidates for RP. Although the association between the PCA3 score and prostate cancer aggressiveness needs further evaluation, the inclusion of the PCA3 score into patient management strategies may provide clinicians with another tool to more accurately determine the course of treatment.
评估前列腺癌基因 3（PCA3）与前列腺癌意义之间的关系。
分析了两项多中心、开放性、前瞻性研究的临床数据，这些研究评估了 PCA3 检测在指导初始和重复活检决策中的临床应用价值。在直肠指检（每叶 3 次）后采集首段尿液，并使用 PROGENSA（®） PCA3 检测试剂盒测定 PCA3 评分。由当地病理学家分析经直肠超声引导活检（≥8 个核心）和根治性前列腺切除术（RP）标本。评估了 PCA3 评分与活检和 RP 结果之间的关系。
在纳入的 1009 名男性中，348 名（34%）的活检结果为阳性。与活检 Gleason 评分<7 与≥7、临床分期 T1c 与 T2a-T2c、T3a 癌、活检阳性核心数≤33%与>33%以及“活检惰性”与“活检显著”前列腺癌（活检 Epstein 标准定义的惰性前列腺癌）相比，具有统计学意义的较低中位数和平均 PCA3 评分。共有 175 名阳性活检的男性接受了 RP：与病理 Gleason 评分<7 与≥7、病理分期 T2a-T2c 与 T3a-T3b 癌相比，具有统计学意义的较低中位数和平均 PCA3 评分。
PCA3 评分与传统工具相结合，可能有助于识别临床意义不显著的前列腺癌患者，这些患者通过活检和 RP 病理特征（包括活检 Epstein 标准）表现出来，这些患者可能是主动监测的候选者。治疗选择应基于临床和病理变量的组合。如果想在临床实践中使用一个阈值点来指导治疗决策，那么 PCA3 评分阈值为 20 可能对选择具有临床意义不显著的前列腺癌患者最有用，这些患者可能适合进行主动监测；PCA3 评分阈值为 50 可能用于识别具有显著前列腺癌高风险的男性，这些患者是 RP 的候选者。尽管 PCA3 评分与前列腺癌侵袭性之间的关系需要进一步评估，但将 PCA3 评分纳入患者管理策略可能为临床医生提供另一种工具，以更准确地确定治疗方案。
