Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
J Urol. 2013 Feb;189(2):422-9. doi: 10.1016/j.juro.2012.04.143. Epub 2012 Sep 24.
Prostate specific antigen and digital rectal examination have low specificity for detecting prostate cancer and they poorly predict the presence of aggressive disease. Urine is readily available and noninvasive, and it represents a promising source of biomarkers for the early detection and prediction of prostate cancer prognosis. We identified promising biomarkers for urine based prostate cancer, examined trends and outlined potential pitfalls.
We performed PubMed® and Web of Science® database searches of the peer reviewed literature on urine based testing for prostate cancer. Original studies of this subject as well as a small number of reviews were analyzed, including the strengths and weaknesses. We provide a comprehensive review of urine based testing for prostate cancer that covers the technical aspects, including the methodology of urine collection, as well as recent developments in biomarkers spanning the fields of genomics, epigenetics, transcriptomics, proteomics and metabolomics.
The process of urine collection is subject to variability, which may result in conflicting clinical results. Detecting prostate cancer in urine is technically feasible, as demonstrated by numerous proof of principle studies, but few markers have been validated in multiple large sample sets. Biomarker development using urine has been accelerating in recent years with numerous studies identifying DNA, RNA, protein and metabolite based biomarkers in urine. Advanced clinical studies have identified PCA3 and TMPRSS2:ERG fusion transcripts as promising RNA markers for cancer detection and possibly prognosis. DNA methylation analysis of multiple genes improves specificity and represents a promising platform for developing clinical grade assays.
Urine based testing is noninvasive and represents a rich source of novel biomarkers for prostate cancer. Although urine shows promise for detecting cancer, the ability to identify aggressive subsets of prostate cancer needs further development.
前列腺特异抗原和直肠指检对前列腺癌的检测特异性较低，对侵袭性疾病的预测能力也较差。尿液易得且无创，是用于前列腺癌早期检测和预测预后的有前途的生物标志物来源。我们鉴定了具有前景的尿液前列腺癌生物标志物，研究了相关趋势并概述了潜在的陷阱。
我们在 PubMed®和 Web of Science®数据库中对基于尿液的前列腺癌检测的同行评议文献进行了检索。分析了该主题的原始研究和少量综述，包括其优缺点。我们对基于尿液的前列腺癌检测进行了全面的综述，涵盖了技术方面，包括尿液收集的方法，以及跨越基因组学、表观遗传学、转录组学、蛋白质组学和代谢组学领域的生物标志物的最新进展。
尿液收集过程存在变异性，这可能导致临床结果不一致。大量的原理验证研究表明，在尿液中检测前列腺癌在技术上是可行的，但在多个大样本集中得到验证的标志物很少。近年来，随着大量研究在尿液中发现基于 DNA、RNA、蛋白质和代谢物的生物标志物，基于尿液的生物标志物开发正在加速。先进的临床研究已经确定 PCA3 和 TMPRSS2:ERG 融合转录本作为癌症检测和可能预后的有前途的 RNA 标志物。对多个基因的 DNA 甲基化分析可提高特异性，代表了开发临床级检测的有前途的平台。
基于尿液的检测是无创的，为前列腺癌提供了丰富的新型生物标志物来源。尽管尿液在检测癌症方面显示出了潜力，但识别侵袭性前列腺癌亚群的能力仍需要进一步发展。
