Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
Department of Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria.
Prostate Cancer Prostatic Dis. 2017 Sep;20(3):271-275. doi: 10.1038/pcan.2017.3. Epub 2017 Mar 21.
One of the major challenges in prostate cancer (PCa) treatment is distinguishing insignificant PCa from those forms that need active treatment. We evaluated the impact of PSA isoforms on risk stratification in patients with low-risk PCa as well as in active surveillance (AS) candidates who underwent radical prostatectomy.
A total of 112 patients with biopsy confirmed Gleason score (GS) 6 PCa of four different international institutions were prospectively enrolled in the study. Blood withdrawal was performed the day before radical prostatectomy. In addition, patients were classified according to the EAU and NCCN criteria for AS candidates. PSA, free PSA (fPSA) and proPSA were measured using dual monoclonal antibody sandwich immunoassays. In addition, the Prostate Health Index (PHI=proPSA/fPSA × √PSA) was calculated. Final histology of the radical prostatectomy specimens was correlated to PSA, its isoforms and PHI.
Serum proPSA levels were significantly elevated in those patients with an upgrade in final histology (GS⩾7). In addition, higher proPSA levels were predictive for extraprostatic extension (⩾pT3a) as well as for positive surgical margins. Interestingly, PHI had an even higher predictive power when compared with proPSA alone concerning GS upgrading, extraprostatic extension and surgical margins in both the total and the AS patient group.
We showed in a multicenter study that proPSA is a valuable biomarker to detect patients with aggressive PCa in a cohort of GS 6 patients, who would benefit from active tumor therapy. Combining proPSA with the standard markers PSA and fPSA using PHI further increases the predictive accuracy significantly. Moreover, our data support the use of PHI for monitoring PCa patients under AS.
前列腺癌（PCa）治疗的主要挑战之一是区分无意义的 PCa 和需要积极治疗的形式。我们评估了 PSA 同工型对低危 PCa 患者以及接受根治性前列腺切除术的主动监测（AS）候选者的风险分层的影响。
共有来自四个不同国际机构的 112 名经活检证实的 GS6 PCa 患者前瞻性入组本研究。在根治性前列腺切除术前一天进行采血。此外，根据 EAU 和 NCCN 的 AS 候选者标准对患者进行分类。使用双单克隆抗体夹心免疫测定法测量 PSA、游离 PSA（fPSA）和 proPSA。此外，还计算了前列腺健康指数（PHI=proPSA/fPSA × √PSA）。将根治性前列腺切除术标本的最终组织学与 PSA、其同工型和 PHI 相关联。
最终组织学升级的患者血清 proPSA 水平显著升高。此外，较高的 proPSA 水平可预测前列腺外延伸（≥pT3a）以及阳性手术切缘。有趣的是，与单独的 proPSA 相比，PHI 在总患者组和 AS 患者组中关于 GS 升级、前列腺外延伸和手术切缘方面具有更高的预测能力。
我们在一项多中心研究中表明，在 GS6 患者队列中，proPSA 是一种有价值的生物标志物，可检测侵袭性 PCa 患者，这些患者将受益于积极的肿瘤治疗。将 proPSA 与标准标志物 PSA 和 fPSA 结合使用 PHI 可进一步显著提高预测准确性。此外，我们的数据支持使用 PHI 监测 AS 下的 PCa 患者。
