Stephan C, Jung K, Miller K, Ralla B
Klinik für Urologie, Charité - Universitätsmedizin Berlin.
Aktuelle Urol. 2015 Mar;46(2):129-43. doi: 10.1055/s-0034-1398544. Epub 2015 Apr 21.
Prostate-specific antigen (PSA) has revolutionized the management of prostate cancer (PCa) within the last 3 decades. This widely used tumour marker strongly correlates with the risk of harbouring a PCa but it lacks specificity. Therefore there is an urgent need for new biomarkers especially to detect clinically significant and aggressive PCa. Of all PSA-based markers, only the FDA-approved prostate health index phi shows improved specificity over percent free (%fPSA) and total PSA. Other serum kallikreins or sarcosine in serum or urine show more ambiguous data. In urine, the FDA-approved prostate cancer gene 3 (PCA3) has also proven its utility in the detection and management of early PCa with advantages as compared with PSA and %fPSA. However, some aspects of its correlation with aggressiveness and the low sensitivity at very high values have to be re-examined. The detection of alterations of the androgen regulated TMPRSS2 and ETS transcription factor genes in tissue of ~50% of all PCa patients was a milestone in PCa research. But only the combination of the urinary assays for TMPRSS2:ERG gene fusion and PCA3 (both use the same platform) show the expected improved accuracy for PCa detection. Comparisons of phi and PCA3, the best available PCa biomarkers so far, show an equal performance of both parameters.
在过去30年里，前列腺特异性抗原（PSA）彻底改变了前列腺癌（PCa）的管理方式。这种广泛使用的肿瘤标志物与患PCa的风险密切相关，但缺乏特异性。因此，迫切需要新的生物标志物，尤其是用于检测具有临床意义和侵袭性的PCa。在所有基于PSA的标志物中，只有美国食品药品监督管理局（FDA）批准的前列腺健康指数phi比游离PSA百分比（%fPSA）和总PSA表现出更高的特异性。血清中的其他激肽释放酶或血清或尿液中的肌氨酸显示的数据则更为模糊。在尿液中，FDA批准的前列腺癌基因3（PCA3）在早期PCa的检测和管理中也证明了其效用，与PSA和%fPSA相比具有优势。然而，其与侵袭性的相关性以及在非常高的值时的低敏感性的某些方面必须重新审视。在约50%的PCa患者组织中检测雄激素调节的跨膜丝氨酸蛋白酶2（TMPRSS2）和ETS转录因子基因的改变是PCa研究中的一个里程碑。但只有TMPRSS2:ERG基因融合和PCA3的尿液检测组合（两者使用相同平台）显示出PCa检测预期的更高准确性。phi和PCA3这两种目前最好的PCa生物标志物的比较显示，这两个参数的表现相当。
