Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Department of Urology, University of Washington, Seattle, WA, USA.
Prostate Cancer Prostatic Dis. 2019 Sep;22(3):438-445. doi: 10.1038/s41391-018-0124-z. Epub 2019 Jan 21.
For men on active surveillance for prostate cancer, biomarkers may improve prediction of reclassification to higher grade or volume cancer. This study examined the association of urinary PCA3 and TMPRSS2:ERG (T2:ERG) with biopsy-based reclassification.
Urine was collected at baseline, 6, 12, and 24 months in the multi-institutional Canary Prostate Active Surveillance Study (PASS), and PCA3 and T2:ERG levels were quantitated. Reclassification was an increase in Gleason score or ratio of biopsy cores with cancer to ≥34%. The association of biomarker scores, adjusted for common clinical variables, with short- and long-term reclassification was evaluated. Discriminatory capacity of models with clinical variables alone or with biomarkers was assessed using receiver operating characteristic (ROC) curves and decision curve analysis (DCA).
Seven hundred and eighty-two men contributed 2069 urine specimens. After adjusting for PSA, prostate size, and ratio of biopsy cores with cancer, PCA3 but not T2:ERG was associated with short-term reclassification at the first surveillance biopsy (OR = 1.3; 95% CI 1.0-1.7, p = 0.02). The addition of PCA3 to a model with clinical variables improved area under the curve from 0.743 to 0.753 and increased net benefit minimally. After adjusting for clinical variables, neither marker nor marker kinetics was associated with time to reclassification in subsequent biopsies.
PCA3 but not T2:ERG was associated with cancer reclassification in the first surveillance biopsy but has negligible improvement over clinical variables alone in ROC or DCA analyses. Neither marker was associated with reclassification in subsequent biopsies.
对于接受前列腺癌主动监测的男性，生物标志物可能有助于预测重新分类为更高等级或更大体积的癌症。本研究探讨了尿 PCA3 和 TMPRSS2:ERG（T2:ERG）与基于活检的重新分类的相关性。
在多机构 Canary 前列腺主动监测研究（PASS）中，在基线、6、12 和 24 个月时收集尿液，并定量检测 PCA3 和 T2:ERG 水平。重新分类是指 Gleason 评分或活检中带癌核心比例增加≥34%。评估了生物标志物评分与常见临床变量调整后的短期和长期重新分类之间的相关性。使用接受者操作特征（ROC）曲线和决策曲线分析（DCA）评估仅具有临床变量或具有生物标志物的模型的区分能力。
782 名男性贡献了 2069 份尿液标本。在调整 PSA、前列腺大小和活检中带癌核心比例后，PCA3 但不是 T2:ERG 与首次监测活检的短期重新分类相关（OR=1.3；95%CI 1.0-1.7，p=0.02）。将 PCA3 添加到具有临床变量的模型中，曲线下面积从 0.743 增加到 0.753，净效益略有增加。在调整临床变量后，在随后的活检中，两种标志物或标志物动力学均与重新分类时间无关。
PCA3 但不是 T2:ERG 与首次监测活检中的癌症重新分类相关，但在 ROC 或 DCA 分析中，与仅临床变量相比，改善程度可忽略不计。两种标志物均与随后的活检中的重新分类无关。
