Murray Nigel P, Reyes Eduardo, Fuentealba Cynthia, Jacob Omar
Hospital Carabineros of Chile, Nunoa, Chile Email :
Asian Pac J Cancer Prev. 2016;17(7):3385-90.
Sequential use of circulating prostate cell (CPC) detection has been reported to potentially decrease the number of unnecessary prostate biopsies in men suspected of prostate cancer. In order to determine the real world effectiveness of the test, we present a prospective study of men referred to two hospitals from primary care physicians, one using CPC detection to determine the necessity of prostate biopsy the other not doing so.
Men with a suspicion of prostate cancer because of elevated PSA >4.0ng/ml or abnormal DRE were referred to Hospitals A or B. In Hospital A all underwent 12 core TRUS biopsy, in Hospital B only men CPC (+), with mononuclear cells obtained by differential gel centrifugation identified using double immunomarking with antiPSA and antiP504S, were recommended to undergo TRUS biopsy. Biopsies were classifed as cancer or nocancer. Diagnostic yields were calculated, including the number of posible biopsies that could be avoided and the number of clinically significant cancers that would be missed.
Totals of 649 men attended Hospital A, and 552 men attended Hospital B; there were no significant differences in age or serum PSA levels. In Hospital A, 228 (35.1%) men had prostate cancer detected, CPC detection had a sensitivity of 80.7%, a specificity of 88.6%, and a negative predictive value of 89.5%. Some 39/44 men CPC negative with a positive biopsy had low grade small volume tumors. In Hospital B, 316 (57.2%) underwent biopsy. There were no significant differences between populations in terms of CPC and biopsy results. The reduction in the number of biopsies was 40%.
The use of sequential CPC testing in the real world gives a clear decision structure for patient management and can reduce the number of biopsies considerably.
据报道，循环前列腺细胞（CPC）检测的序贯使用可能会减少疑似前列腺癌男性不必要的前列腺活检数量。为了确定该检测在现实世界中的有效性，我们对从基层医疗医生转诊至两家医院的男性进行了一项前瞻性研究，其中一家医院使用CPC检测来确定前列腺活检的必要性，另一家则不使用。
因PSA升高>4.0ng/ml或直肠指检异常而疑似前列腺癌的男性被转诊至A医院或B医院。在A医院，所有患者均接受12针经直肠超声引导下活检；在B医院，仅推荐CPC（+）的男性进行经直肠超声引导下活检，通过差异凝胶离心法获得的单核细胞使用抗PSA和抗P504S双重免疫标记进行鉴定。活检结果分为癌症或非癌症。计算诊断率，包括可避免的可能活检数量以及可能漏诊的临床显著癌症数量。
共有649名男性前往A医院，552名男性前往B医院；年龄或血清PSA水平无显著差异。在A医院，228名（35.1%）男性检测出前列腺癌，CPC检测的敏感性为80.7%，特异性为88.6%，阴性预测值为89.5%。约39/44名CPC阴性但活检阳性的男性患有低级别小体积肿瘤。在B医院，316名（57.2%）患者接受了活检。两组人群在CPC和活检结果方面无显著差异。活检数量减少了40%。
在现实世界中使用序贯CPC检测可为患者管理提供明确的决策框架，并可大幅减少活检数量。
