Department of Molecular Medicine, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Sci Rep. 2022 Sep 7;12(1):15193. doi: 10.1038/s41598-022-19460-6.
Elevated prostate-specific antigen (PSA) levels often lead to unnecessary and possibly harmful transrectal ultrasound guided biopsy, e.g. when the biopsy is negative or contains only low-grade insignificant cancer, unlikely to become symptomatic in the man's normal lifespan. A model based on four-kallikrein markers in blood (commercialized as 4Kscore) predicts risk of Grade group 2 or higher prostate cancer at biopsy, reducing unnecessary biopsies. We assessed whether these results extend to a single institution prostate biopsy cohort of Danish men and are enhanced by three microRNAs from urine (referred to as uCaP). The 4Kscore measured in cryopreserved blood from 234 men referred for 10+ core biopsy to Aarhus University Hospital, 29 with PSA > 25 ng/ml. We explored uCaP in urine from 157 of these men. Combined with age and DRE findings, both 4Kscore and uCaP could accurately predict Grade group 2 or higher prostate cancer (all patients: AUC = 0.802 and 0.797; PSA ≤ 25: AUC = 0.763 and 0.759). There was no additive effect when combining the 4Kscore and uCaP. Limitations include a study cohort with higher risk than commonly reported for biopsy cohorts. Our findings further support the clinical use of the 4Kscore to predict Grade group 2 or higher cancers in men being considered for biopsy.
前列腺特异性抗原 (PSA) 水平升高常导致不必要且可能有害的经直肠超声引导活检，例如活检结果为阴性或仅包含低级别、无意义的癌症，且不太可能在男性正常寿命内出现症状。一种基于血液中四种激肽原标志物（商业化的 4Kscore）的模型预测活检时 2 级及以上前列腺癌的风险，从而减少不必要的活检。我们评估了这些结果是否适用于丹麦单家机构的前列腺活检队列，并通过尿液中的三种 microRNA（称为 uCaP）来增强这些结果。在 Aarhus 大学医院对 234 名因 10+ 核心活检而就诊的男性进行了冷冻血液中的 4Kscore 检测，其中 29 名患者的 PSA > 25ng/ml。我们对其中 157 名男性的尿液中的 uCaP 进行了探索。结合年龄和 DRE 发现，4Kscore 和 uCaP 都可以准确预测 2 级及以上前列腺癌（所有患者：AUC=0.802 和 0.797；PSA≤25：AUC=0.763 和 0.759）。同时结合 4Kscore 和 uCaP 没有叠加效果。研究队列的局限性在于其风险高于通常报道的活检队列。我们的研究结果进一步支持使用 4Kscore 预测考虑活检的男性中 2 级及以上癌症的临床应用。
