Borbiev Talaibek, Kohaar Indu, Petrovics Gyorgy
Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, USA.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA.
Cancers (Basel). 2023 Dec 28;16(1):165. doi: 10.3390/cancers16010165.
This mini review summarizes the currently available clinical biofluid assays for PCa. The second most prevalent cancer worldwide is PCa. PCa is a heterogeneous disease, with a large percentage of prostate tumors being indolent, and with a relatively slow metastatic potential. However, due to the high case numbers, the absolute number of PCa-related deaths is still high. In fact, it causes the second highest number of cancer deaths in American men. As a first step for the diagnosis of PCa, the PSA test has been widely used. However, it has low specificity, which results in a high number of false positives leading to overdiagnosis and overtreatment. Newer derivatives of the original PSA test, including the Food and Drug Administration (FDA)-approved 4K (four kallikreins) and the PHI (Prostate Health Index) blood tests, have higher specificities. Tissue-based PCa tests are problematic as biopsies are invasive and have limited accuracy due to prostate tumor heterogeneity. Liquid biopsies offer a minimally or non-invasive choice for the patients, while providing a more representative reflection of the spatial heterogeneity in the prostate. In addition to the abovementioned blood-based tests, urine is a promising source of PCa biomarkers, offering a supplementary avenue for early detection and improved tumor classification. Four urine-based PCa tests are either FDA- or CLIA-approved: PCA3 (PROGENSA), ExoDX Prostate Intelliscore, MiPS, and SelectMDx. We will discuss these urine-based, as well as the blood-based, clinical PCa tests in more detail. We also briefly discuss a few promising biofluid marker candidates (DNA methylation, micro-RNAs) which are not in clinical application. As no single assay is perfect, we envision that a combination of biomarkers, together with imaging, will become the preferred practice.
本综述总结了目前可用于前列腺癌（PCa）的临床生物流体检测方法。前列腺癌是全球第二大常见癌症。前列腺癌是一种异质性疾病，很大比例的前列腺肿瘤生长缓慢，转移潜力相对较低。然而，由于病例数量众多，前列腺癌相关死亡的绝对数量仍然很高。事实上，它是美国男性中导致癌症死亡人数第二多的癌症。作为前列腺癌诊断的第一步，前列腺特异性抗原（PSA）检测已被广泛应用。然而，它的特异性较低，导致大量假阳性结果，进而导致过度诊断和过度治疗。原始PSA检测的更新衍生物，包括美国食品药品监督管理局（FDA）批准的4K（四种激肽释放酶）和前列腺健康指数（PHI）血液检测，具有更高的特异性。基于组织的前列腺癌检测存在问题，因为活检具有侵入性，且由于前列腺肿瘤的异质性，其准确性有限。液体活检为患者提供了微创或无创的选择，同时能更有代表性地反映前列腺的空间异质性。除了上述基于血液的检测方法外，尿液是前列腺癌生物标志物的一个有前景的来源，为早期检测和改善肿瘤分类提供了一条补充途径。四种基于尿液的前列腺癌检测方法已获得FDA或临床实验室改进修正案（CLIA）的批准：PCA3（PROGENSA）、ExoDX前列腺智能评分、MiPS和SelectMDx。我们将更详细地讨论这些基于尿液以及基于血液的临床前列腺癌检测方法。我们还简要讨论了一些有前景但尚未应用于临床的生物流体标志物候选物（DNA甲基化、微小RNA）。由于没有一种检测方法是完美的，我们设想生物标志物与成像技术相结合将成为首选的做法。
