Cama C, Olsson C A, Raffo A J, Perlman H, Buttyan R, O'Toole K, McMahon D, Benson M C, Katz A E
Department of Urology, Columbia University, College of Physicians and Surgeons, New York, New York, USA.
J Urol. 1995 May;153(5):1373-8.
Current imaging modalities used to stage prostate cancer clinically fail to detect extracapsular disease in a significant subset of patients. A molecular based peripheral blood assay using the reverse transcriptase polymerase chain reaction has recently been shown to be a highly sensitive staging modality for detecting extraprostatic disease preoperatively. The assay uses primers that are specific for prostate specific antigen (PSA). We compare the application of the reverse transcriptase polymerase chain reaction assay using primers specific for the human prostate specific membrane antigen with results obtained from the same specimens by reverse transcriptase polymerase chain reaction for PSA. Prostate specific membrane antigen, a recently cloned prostatic antigen, is a transmembrane glycoprotein that has been described as prostate specific. These assays were applied to ribonucleic acids extracted from the peripheral blood lymphocyte fraction of 80 patients with clinically localized prostate cancer. In addition, blood specimens from 20 female patients, 20 young male patients, 25 age-matched control men under treatment for benign prostatic hypertrophy and 20 men with established, untreated metastatic prostate cancer were tested. All 3 groups of noncancer patients had negative polymerase chain reactions for PSA as well as prostate specific membrane antigen. Of 20 metastatic prostate cancer patients 16 (80%) had positive polymerase chain reactions for PSA, while only 10 (50%) had positive results for prostate specific membrane antigen. Among the 80 patients with clinically localized disease (stages T1 to T2cN0M0), 27 and 19 had positive polymerase chain reaction for PSA and prostate specific membrane antigen, respectively, from blood specimens obtained preoperatively. Analyzing the final pathology in each patient with the reverse transcriptase polymerase chain reaction assay identified a significantly stronger correlation with tumor invasion using the results of the PSA test rather than the results of the prostate specific membrane antigen reverse transcriptase polymerase chain reaction test (67% versus 34% sensitivity for detecting capsular penetration, 87% versus 46% sensitivity for detecting disease to the surgical margin and 83% versus 16% sensitivity for detecting seminal vesicle invasion). In contrast to the reverse transcriptase polymerase chain reaction assay for PSA, a similar assay done for prostate specific membrane antigen did not correlate with pathological stage of prostate cancer.
目前临床上用于前列腺癌分期的成像方法在相当一部分患者中无法检测出包膜外疾病。最近，一种基于分子的外周血检测方法，即逆转录酶聚合酶链反应，已被证明是一种高度敏感的术前检测前列腺外疾病的分期方法。该检测方法使用对前列腺特异性抗原（PSA）特异的引物。我们将使用对人前列腺特异性膜抗原特异的引物的逆转录酶聚合酶链反应检测方法的应用与通过针对PSA的逆转录酶聚合酶链反应从相同标本获得的结果进行比较。前列腺特异性膜抗原是一种最近克隆的前列腺抗原，是一种跨膜糖蛋白，已被描述为前列腺特异性的。这些检测方法应用于从80例临床局限性前列腺癌患者的外周血淋巴细胞部分提取的核糖核酸。此外，还检测了20例女性患者、20例年轻男性患者、25例年龄匹配的正在接受良性前列腺增生治疗的对照男性以及20例已确诊、未治疗的转移性前列腺癌男性的血液标本。所有3组非癌症患者的PSA以及前列腺特异性膜抗原的聚合酶链反应均为阴性。在20例转移性前列腺癌患者中，16例（80%）的PSA聚合酶链反应呈阳性，而只有10例（50%）的前列腺特异性膜抗原检测结果呈阳性。在80例临床局限性疾病（T1至T2cN0M0期）患者中，分别有27例和19例术前血液标本的PSA和前列腺特异性膜抗原的聚合酶链反应呈阳性。通过逆转录酶聚合酶链反应检测分析每位患者的最终病理结果发现，与肿瘤侵犯的相关性在PSA检测结果方面明显强于前列腺特异性膜抗原逆转录酶聚合酶链反应检测结果（检测包膜穿透的敏感性分别为67%对34%，检测手术切缘疾病的敏感性分别为87%对46%，检测精囊侵犯的敏感性分别为83%对16%）。与针对PSA的逆转录酶聚合酶链反应检测不同，针对前列腺特异性膜抗原进行的类似检测与前列腺癌的病理分期无关。
