Murray N P, Reyes E, Tapia P, Badinez L, Orellana N, Fuentealba C, Olivares R, Dueñas R
Hospital Carabineros of Chile, Ñuñoa, Santiago, Chile.
Arch Esp Urol. 2013 May;66(4):335-41.
Serum prostate specific antigen and digital rectal examination are the tests used as screening tests to detect prostate cancer. However, only approximately 30% of men with suspicion of cancer have it confirmed on prostate biopsy, and not all of these need treatment. Detection of circulating tumor cells in localized prostate cancer has given variable results, but it could be a useful complementary screening tool to detect prostate cancer in men with abnormal screening tests before the evaluation with prostate biopsy. This may be more so in subsequent biopsies where serum PSA has a decreased diagnostic yield. To evaluate the diagnostic yield of the detection of CPCs as a complementary PC screening test in a population fulfilling criteria for an initial, second and third prostate biopsy for suspicion of PC.
A prospective screening study of consecutive patients aged 45-80 years presenting to the urologist for PC screening. Inclusion criteria were PSA >4.0 ng/ml, PSA velocity >0.35 ng/ml/year and/or DRE suspicious for cancer. Patients fulfilling inclusion criteria had blood taken for CPC detection and then underwent 12-core transrectal prostate biopsy. Double immune-his-tochemical staining with anti-PSA and anti-P504S was used to detect CPCs. Both cytologist and pathologist were blinded to the results of the biopsy, CPC results and clinical details. The diagnostic yield of the presence or absence of CPC was evaluated; the prostate biopsy was classified as cancer or no-cancer.
282 men participated, 83 undergoing of these undergoing a second and 38 a third biopsy, with a mean age of 66.2 ± 8.9 years and a median serum PSA of 5.10 ng/ml, 5.45 ng/ml and 6.45 ng/ml for first, second and third biopsies. Cancer was detected in 33,6%, 10.8% and 29.0% of first, second and third biopsies respectively, CPCs were detected in 36.9%, 21.7% and 36.8% of the patients. Sensibility, specificity and negative predictive value were 86% ,91% and 94% for the first biopsy, 89%, 87% and 99% for the second and 100% , 89% and 100% for third biopsy respectively. All the CPC determinations were interpretable. There were 11 false negative cases, all with small low grade tumors. Of the 29 men with a false positive CPC, 8/10 had cancer detected in the subsequent biopsy.
The use of CPC detection could be useful as a complementary prostate cancer screening test, especially for excluding cancer, and including patients with indications for repeat biopsies. Men with a false positive CPC detection had a high risk of detecting cancer in the succeeding biopsy.
血清前列腺特异性抗原检测和直肠指检是用于筛查前列腺癌的检查方法。然而，仅有约30%疑似患有癌症的男性经前列腺活检确诊，且并非所有确诊患者都需要治疗。在局限性前列腺癌中检测循环肿瘤细胞的结果存在差异，但它可能是一种有用的辅助筛查工具，可在前列腺活检评估前，对筛查结果异常的男性检测前列腺癌。在后续活检中，血清PSA的诊断率下降，情况可能更是如此。本研究旨在评估在符合首次、第二次和第三次前列腺活检疑似前列腺癌标准的人群中，检测循环肿瘤细胞（CPC）作为辅助前列腺癌筛查检查的诊断率。
对连续就诊于泌尿外科医生进行前列腺癌筛查的45 - 80岁患者进行前瞻性筛查研究。纳入标准为PSA>4.0 ng/ml、PSA速率>0.35 ng/ml/年和/或直肠指检怀疑癌症。符合纳入标准的患者采集血液用于检测CPC，然后接受12针经直肠前列腺活检。采用抗PSA和抗P504S双重免疫组织化学染色检测CPC。细胞学家和病理学家均对活检结果、CPC结果及临床细节不知情。评估CPC存在与否的诊断率；前列腺活检分为癌症或非癌症。
282名男性参与研究，其中83人接受了第二次活检，38人接受了第三次活检，首次、第二次和第三次活检患者的平均年龄为66.2±8.9岁，血清PSA中位数分别为5.10 ng/ml、5.45 ng/ml和6.45 ng/ml。首次、第二次和第三次活检分别在33.6%、10.8%和29.0%的患者中检测到癌症，分别在36.9%、21.7%和36.8%的患者中检测到CPC。首次活检的敏感性、特异性和阴性预测值分别为86%、91%和94%，第二次活检分别为89%、87%和99%，第三次活检分别为100%、89%和100%。所有CPC检测结果均可解读。有11例假阴性病例，均为小的低级别肿瘤。在29例CPC假阳性男性中，8/10在后续活检中检测到癌症。
检测CPC可作为一种有用的辅助前列腺癌筛查检查，尤其有助于排除癌症，并纳入有重复活检指征的患者。CPC检测假阳性的男性在后续活检中检测到癌症的风险较高。
