Murray Nigel P, Reyes Eduardo, Orellana Nelson, Fuentealba Cynthia, Jacob Omar
Hospital Carabineros of Chile, Nunoa, Santiago, Chile E-mail :
Asian Pac J Cancer Prev. 2016;17(6):2941-6.
The limitations of total serum PSA values remain problematic, especially after an initial negative prostate biopsy. In this prospective study of Chilean men with a continued suspicion of prostate cancer due to a persistently elevated total serum PSA, abnormal digital rectal examination and initial negative prostate biopsy were compared with the use of the on-line Chun nomagram, detection of primary malignant circulating prostate cells (CPCs) and free percent PSA to predict a positive second prostate biopsy. We hypothesized that men negative for circulating prostate cells have a small risk of clinically significant prostate cancer and thus may be conservatively observed. Men positive for circulating prostate cells should undergo biopsy to confirm prostate cancer.
Consecutive men with a continued suspicion of prostate cancer underwent 12 core TRUS prostate biopsy; age, total serum PSA and percentage free PSA and Chun nomagram scores were registered. Immediately before biopsy an 8ml blood simple was taken to detect primary mCPCs. Mononuclear cells were obtained by differential gel centrifugation and identified using double immunostaining with anti-PSA and anti-P504S. Biopsies were classifed as cancer/no-cancer, mCPC detecton test as negative/positive and the total number of cells/8ml registered. Areas under the curve (AUC) for percentage free PSA, Chun score and CPCs were calculated and compared. Diagnostic yields were calculated with reference to the number of possible biopsies that could be avoided and the number of clinically significant cancers that would be missed.
A total of 164 men underwent a second biopsy; 41 (25%) had cancer; the AUCs were 0.65 for free PSA, 0.76 for the Chun score and 0.87 for CPC detection, the last having a significantly superior prediction value (p=0.01). Using cut off values of free PSA <10%, Chun score >50% and ≥1 CPC detected, CPC detection had a higher diagnostic yield. Some 4/41 cancers complied with the criteria for active surveillance, free PSA and the Chun score missed a higher number of significant cancers when compared with CPC detection.
Primary CPC detection outperformed the use of free PSA and the Chun nomagram in predicting clinically significant prostate cancer at repeat prostate biopsy.
总血清前列腺特异抗原（PSA）值的局限性仍然存在问题，尤其是在初次前列腺活检为阴性之后。在这项针对因总血清PSA持续升高而仍怀疑患有前列腺癌的智利男性的前瞻性研究中，将异常直肠指检和初次前列腺活检阴性与使用在线春氏列线图、检测原发性恶性循环前列腺细胞（CPC）以及游离PSA百分比进行比较，以预测第二次前列腺活检结果为阳性。我们假设循环前列腺细胞检测为阴性的男性患临床显著性前列腺癌的风险较小，因此可以进行保守观察。循环前列腺细胞检测为阳性的男性应接受活检以确诊前列腺癌。
对持续怀疑患有前列腺癌的男性连续进行12针经直肠超声引导下前列腺活检；记录年龄、总血清PSA、游离PSA百分比和春氏列线图评分。在活检前即刻采集8ml血液样本以检测原发性mCPC。通过差速凝胶离心获得单核细胞，并使用抗PSA和抗P504S双重免疫染色进行鉴定。活检分为癌症/非癌症，mCPC检测试验分为阴性/阳性，并记录每8ml中的细胞总数。计算并比较游离PSA百分比、春氏评分和CPC的曲线下面积（AUC）。根据可避免的可能活检数量和漏诊的临床显著性癌症数量计算诊断率。
共有164名男性接受了第二次活检；41名（25%）患有癌症；游离PSA的AUC为0.65，春氏评分的AUC为0.76，CPC检测的AUC为0.87，最后一项具有显著更高的预测价值（p=0.01）。使用游离PSA<10%、春氏评分>50%和检测到≥1个CPC的临界值时，CPC检测具有更高的诊断率。41例癌症中有4例符合主动监测标准，与CPC检测相比，游离PSA和春氏评分漏诊的显著癌症数量更多。
在预测重复前列腺活检时的临床显著性前列腺癌方面，原发性CPC检测优于游离PSA和春氏列线图的应用。
