Schmid Marianne, Hansen Jens, Chun Felix K-H
Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Adv Exp Med Biol. 2015;867:277-89. doi: 10.1007/978-94-017-7215-0_17.
Due to low specificity of Prostate-Specific Antigen (PSA) we face a certain risk of overdiagnosis and overtreatment of Prostate Cancer (PCa). The benefits and harms of PSA-screening are controversially discussed. To overcome this weakness of PSA novel PCa biomarkers and detection tools are required.The urine-based biomarker Prostate Cancer Antigen 3 (PCA3) has been shown to be highly PCa-specific. Application of PCA3 was tested in the diagnostic setting and staging. Several studies pointed out the additional value of PCA3 for further stratification of men selected for biopsy (BX) based on an elevated PSA and/or an abnormal digital rectal examination (DRE). Its combined use with established clinical risk factors for positive prostate BX, particularly within nomograms or risk calculators, may represent a valid and helpful aid for clinicians in patient counselling and BX indication confirmation.When it comes to prediction of favourable or unfavourable histopathological features, respectively, such as tumour volume or PCa significance, PCA3's value remains controversial. Based on relatively small patient numbers, PCA3 has been identified to independently predict small-volume and insignificant PCa. However, in other studies PCA3 was not associated with advanced disease and its ability of predicting PCa aggressiveness in men undergoing radical prostatectomy is limited.PCA3's value may be best given for BX outcome prediction. Finally, the implementation of the PCA3 promoter in developing new highly PCa-specific gene therapies represents a promising perspective in the near future.
由于前列腺特异性抗原（PSA）的低特异性，我们面临前列腺癌（PCa）过度诊断和过度治疗的一定风险。PSA筛查的益处和危害存在争议。为克服PSA的这一弱点，需要新型的PCa生物标志物和检测工具。基于尿液的生物标志物前列腺癌抗原3（PCA3）已被证明具有高度的PCa特异性。已在诊断和分期环境中测试了PCA3的应用。多项研究指出，PCA3对于基于PSA升高和/或直肠指检（DRE）异常而被选作活检（BX）的男性进行进一步分层具有附加价值。将其与前列腺BX阳性的既定临床风险因素联合使用，尤其是在列线图或风险计算器中，可能对临床医生进行患者咨询和确认BX指征是一种有效且有用的帮助。当分别预测有利或不利的组织病理学特征，如肿瘤体积或PCa的意义时，PCA3的价值仍存在争议。基于相对较少的患者数量，已确定PCA3可独立预测小体积和无意义的PCa。然而，在其他研究中，PCA3与晚期疾病无关，其在接受根治性前列腺切除术的男性中预测PCa侵袭性的能力有限。PCA3的价值可能在预测BX结果方面最为突出。最后，在开发新的高度PCa特异性基因疗法中实施PCA3启动子在不久的将来代表着一个有前景的方向。
