Ferro Matteo, Lucarelli Giuseppe, Bruzzese Dario, Perdonà Sisto, Mazzarella Claudia, Perruolo Giuseppe, Marino Ada, Cosimato Vincenzo, Giorgio Emilia, Tagliamonte Virginia, Bottero Danilo, De Cobelli Ottavio, Terracciano Daniela
Division of Urology, European Institute of Oncology, Milan, Italy.
Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, Bari, Italy.
Anticancer Res. 2015 Feb;35(2):1017-23.
BACKGROUND/AIM: Several efforts have been made to find biomarkers that could help clinicians to preoperatively determine prostate cancer (PCa) pathological characteristics and choose the best therapeutic approach, avoiding over-treatment. On this effort, prostate cancer antigen 3 (PCA3), prostate health index (phi) and sarcosine have been presented as promising tools. We evaluated the ability of these biomarkers to predict the pathologic PCa characteristics within a prospectively collected contemporary cohort of patients who underwent radical prostatectomy (RP) for clinically localized PCa at a single high-volume Institution.
The prognostic performance of PCA3, phi and sarcosine were evaluated in 78 patients undergoing RP for biopsy-proven PCa. Receiver operating characteristic (ROC) curve analyses tested the accuracy (area under the curve (AUC)) in predicting PCa pathological characteristics. Decision curve analyses (DCA) were used to assess the clinical benefit of the three biomarkers.
We found that PCA3, phi and sarcosine levels were significantly higher in patients with tumor volume (TV)≥0.5 ml, pathologic Gleason sum (GS)≥7 and pT3 disease (all p-values≤0.01). ROC curve analysis showed that phi is an accurate predictor of high-stage (AUC 0.85 [0.77-0.93]), high-grade (AUC 0.83 [0.73-0.93]) and high-volume disease (AUC 0.94 [0.88-0.99]). Sarcosine showed a comparable AUC (0.85 [0.76-0.94]) only for T3 stage prediction, whereas PCA3 score showed lower AUCs, ranging from 0.74 (for GS) to 0.86 (for TV).
PCA3, phi and sarcosine are predictors of PCa characteristics at final pathology. Successful clinical translation of these findings would reduce the frequency of surveillance biopsies and may enhance acceptance of active surveillance (AS).
背景/目的：人们已做出多项努力来寻找生物标志物，以帮助临床医生在术前确定前列腺癌（PCa）的病理特征，并选择最佳治疗方法，避免过度治疗。在此过程中，前列腺癌抗原3（PCA3）、前列腺健康指数（phi）和肌氨酸已被视为有前景的工具。我们在一个前瞻性收集的当代队列中评估了这些生物标志物预测接受根治性前列腺切除术（RP）治疗临床局限性PCa的患者的病理PCa特征的能力，该队列来自一家大型机构。
对78例经活检证实为PCa且接受RP治疗的患者，评估PCA3、phi和肌氨酸的预后性能。采用受试者工作特征（ROC）曲线分析来测试预测PCa病理特征的准确性（曲线下面积（AUC））。决策曲线分析（DCA）用于评估这三种生物标志物的临床获益。
我们发现，肿瘤体积（TV）≥0.5 ml、病理Gleason评分（GS）≥7和pT3期疾病患者的PCA3、phi和肌氨酸水平显著更高（所有p值≤0.01）。ROC曲线分析表明，phi是高分期（AUC 0.85 [0.77 - 0.93]）、高分级（AUC 0.83 [0.73 - 0.93]）和高体积疾病（AUC 0.94 [0.88 - 0.99]）的准确预测指标。肌氨酸仅在T3期预测方面显示出相当的AUC（0.85 [0.76 - 0.94]），而PCA3评分的AUC较低，范围从0.74（对于GS）到0.86（对于TV）。
PCA3、phi和肌氨酸是最终病理中PCa特征的预测指标。这些研究结果的成功临床转化将减少监测活检的频率，并可能提高主动监测（AS）的接受度。
