Ye Lie-Fu, He Sha, Wu Xiaopei, Jiang Shengying, Zhang Ruo-Chen, Yang Ze-Song, Chen Fa-Wen, Pan Dan-Ling, Li Dong, Li Gang
Department of Urology, Fujian Provincial Hospital, Fuzhou, Fujian, China.
Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China.
Prostate Cancer. 2020 Jan 31;2020:3964615. doi: 10.1155/2020/3964615. eCollection 2020.
Although prostate biopsy is the gold standard for the diagnosis of prostate cancer, it also leads to high incidence of negative biopsies and the diagnosis of clinically low-risk prostate cancer and the subsequent overtreatment. It remains an unmet need to discover new biomarkers in order to defer the unnecessary biopsies in clinical practice. In this study, we described a new method, LBXexo score, to measure the urine exosomal PCA3/PRAC expression from non-DRE urine as a noninvasive diagnosis to improve the detection rate in Chinese population with a low serum PSA level. First-voided urine samples were collected to isolate exosomes, and exosomal RNAs of PCA3 and PRAC were measured by quantitative reverse transcription PCR. A significant increase in exoPCA3/PRAC was observed in both any-grade and high-grade prostate cancer groups when compared with the biopsy-negative group. Receiver-operating characteristic curve analyses showed that the LBXexo score significantly improved diagnostic performance in predicting biopsy results, with AUCs of 0.723 (=0.017) and 0.736 (=0.038) for any-grade and high-grade (GS ≥ 7) prostate cancer, respectively. For high-grade cancer, LBXexo had the negative and positive predictive values of 100% and 27.59%, respectively, and could potentially avoid unnecessary biopsy. This is the first report in Chinese population that demonstrates the predictive value of the exosomal expression of PCA3 and PRAC derived from non-DRE urine in predicting prostate biopsy outcomes. It could be used in clinical practice to make a better informed biopsy decision and avoid unnecessary biopsies in Chinese population.
尽管前列腺活检是诊断前列腺癌的金标准，但它也导致阴性活检的高发生率以及临床低风险前列腺癌的诊断和随后的过度治疗。在临床实践中，发现新的生物标志物以避免不必要的活检仍然是一个未满足的需求。在本研究中，我们描述了一种新方法，即LBXexo评分，用于测量非直肠指检（DRE）尿液中的尿外泌体PCA3/PRAC表达，作为一种非侵入性诊断方法，以提高中国低血清PSA水平人群的检测率。收集首次排尿的尿液样本以分离外泌体，并通过定量逆转录PCR测量PCA3和PRAC的外泌体RNA。与活检阴性组相比，在任何分级和高级别前列腺癌组中均观察到外泌体PCA3/PRAC显著增加。受试者工作特征曲线分析表明，LBXexo评分在预测活检结果方面显著提高了诊断性能，任何分级和高级别（GS≥7）前列腺癌的曲线下面积（AUC）分别为0.723（=0.017）和0.736（=0.038）。对于高级别癌症，LBXexo的阴性和阳性预测值分别为100%和27.59%，并有可能避免不必要的活检。这是中国人群中第一份证明非DRE尿液来源的PCA3和PRAC外泌体表达在预测前列腺活检结果方面的预测价值的报告。它可用于临床实践，以便做出更明智的活检决策，并避免中国人群中不必要的活检。
