Fujizuka Yuji, Ito Kazuto, Oki Ryo, Suzuki Rie, Sekine Yoshitaka, Koike Hidekazu, Matsui Hiroshi, Shibata Yasuhiro, Suzuki Kazuhiro
Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Int J Urol. 2017 Aug;24(8):602-609. doi: 10.1111/iju.13381. Epub 2017 May 31.
To investigate the predictive value of various molecular forms of prostate-specific antigen in men with baseline prostate-specific antigen <2.0 ng/mL.
The case cohort comprised 150 men with a baseline prostate-specific antigen level <2.0 ng/mL, and who developed prostate cancer within 10 years. The control cohort was 300 baseline prostate-specific antigen- and age-adjusted men who did not develop prostate cancer. Serum prostate-specific antigen, free prostate-specific antigen, and [-2] proenzyme prostate-specific antigen were measured at baseline and last screening visit. The predictive impact of baseline prostate-specific antigen- and [-2] proenzyme prostate-specific antigen-related indices on developing prostate cancer was investigated. The predictive impact of those indices at last screening visit and velocities from baseline to final screening on tumor aggressiveness were also investigated.
The baseline free to total prostate-specific antigen ratio was a significant predictor of prostate cancer development. The odds ratio was 6.08 in the lowest quintile baseline free to total prostate-specific antigen ratio subgroup. No serum indices at diagnosis were associated with tumor aggressiveness. The Prostate Health Index velocity and [-2] proenzyme prostate-specific antigen/free prostate-specific antigen velocity significantly increased in patients with higher risk D'Amico risk groups and higher Gleason scores.
Free to total prostate-specific antigen ratio in men with low baseline prostate-specific antigen levels seems to predict the risk of developing prostate cancer, and it could be useful for a more effective individualized screening system. Longitudinal changes in [-2] proenzyme prostate-specific antigen-related indices seem to correlate with tumor aggressiveness, and they could be used as prognostic tool before treatment and during active surveillance.
研究基线前列腺特异性抗原水平<2.0 ng/mL的男性中各种分子形式的前列腺特异性抗原的预测价值。
病例队列包括150名基线前列腺特异性抗原水平<2.0 ng/mL且在10年内发生前列腺癌的男性。对照队列是300名基线前列腺特异性抗原和年龄匹配且未发生前列腺癌的男性。在基线和最后一次筛查访视时测量血清前列腺特异性抗原、游离前列腺特异性抗原和[-2] 前体酶前列腺特异性抗原。研究基线前列腺特异性抗原和[-2] 前体酶前列腺特异性抗原相关指标对前列腺癌发生的预测影响。还研究了最后一次筛查访视时这些指标以及从基线到最终筛查的变化速度对肿瘤侵袭性的预测影响。
基线游离前列腺特异性抗原与总前列腺特异性抗原比值是前列腺癌发生的重要预测指标。在基线游离前列腺特异性抗原与总前列腺特异性抗原比值最低的五分位数亚组中，比值比为6.08。诊断时的血清指标与肿瘤侵袭性均无关联。前列腺健康指数变化速度和[-2] 前体酶前列腺特异性抗原/游离前列腺特异性抗原变化速度在高风险达米科风险组和高 Gleason 评分患者中显著升高。
基线前列腺特异性抗原水平低的男性中游离前列腺特异性抗原与总前列腺特异性抗原比值似乎可预测前列腺癌发生风险，可能有助于建立更有效的个体化筛查系统。[-2] 前体酶前列腺特异性抗原相关指标的纵向变化似乎与肿瘤侵袭性相关，可在治疗前和主动监测期间用作预后工具。
