The incidence of prostate cancer （PCa） is rising steadily among males in many countries. Serum prostate-specific antigen （PSA） is widely applied to clinical diagnosis and screening of PCa. However, the so-called g...The incidence of prostate cancer （PCa） is rising steadily among males in many countries. Serum prostate-specific antigen （PSA） is widely applied to clinical diagnosis and screening of PCa. However, the so-called grey area of PSA levels 4.0-10.0 ng/mL has a low specificity of 25-40% resulting in a high rate of negative biopsy and overtreatment. So in order to treat PCa patients in early stage, there is an urgent need for new biomarkers in PCa diagnosis. The PCA3 gene, a non-coding RNA （ncRNA） that is highly expressed in prostate cancer （PCa） cells, has been identified as a molecular biomarkers to detect PCa, of which PCA3 has already under clinical application. PCA3 is strongly overexpressed in malignant prostate tissue compared to benign or normal adjacent one. Newly, PCA3 is considered to be a promising biomarker in clinical diagnosis and targeted therapy. The diagnostic significance of PCA3, however, is awaiting further researches. Moreover, it has been demonstrated recently that TMPRSS2-ERG gene fusion is identified as the predominant genetic change in patients diagnosed with PCa. Recent study revealed that combination of the PC43 and TMPRSS2-ERG gene fusion test optimizes PCa detection compared with that of single biomarker, which would lead to a considerable reduction of the number of prostate biopsies. In this review, we focused on the potential use of PCA3 and TMPRSS2-ERG gene fusion detection in the diagnosis of PCa.展开更多
Purpose: It is now generally accepted that PSA screening identifies many prostate cancers that are low-risk and may not need treatment. PCA3 is a prostate cancer-specific marker with improved diagnostic accuracy when ...Purpose: It is now generally accepted that PSA screening identifies many prostate cancers that are low-risk and may not need treatment. PCA3 is a prostate cancer-specific marker with improved diagnostic accuracy when compared with PSA in research studies. It remains unknown whether PCA3 testing can reduce the unnecessary diagnosis and treatment of prostate cancer in routine practice. We evaluated whether the use of PCA3 in clinical practice decreases the number of biopsies being performed in response to PSA testing. Methods: 64 consecutive patients undergoing PCA3 measurement in a single community-based urology practice were analyzed for rates of biopsy performance and prostate cancer detection. Results: Median PSA was 5.0 (range: 0.4 - 38.6) and 50% had undergone prior biopsy without evidence of cancer. Median PCA3 score was 13.6 (range: 1.6 - 133.0) with 14 patients having an elevated PCA3 (>35). Prostate biopsy was avoided in 50 of 64 patients (78%). Of the 11 patients undergoing biopsy for abnormal PCA3, 7 had prostate cancer (64%). At >2-year median follow-up, 39 of the remaining 50 patients (78%) avoided subsequent biopsy. Only 5 prostate cancers were diagnosed during follow-up. Conclusions: When used in routine clinical practice, PCA3 appears to reduce the number of biopsies being performed in response to elevated PSA. Given the increasing interest in strategies to reduce unnecessary prostate cancer diagnosis and treatment, this FDA-approved and widely-available molecular test appears to achieve these goals. Further testing will clarify the role of PCA3 in initial and subsequent prostate cancer screening paradigms.展开更多
基金supported by the following grants: National Natural Science Foundation of China No. 31571413, 31201037 (to Dr. Yu) and No. 81570180, 81072103 (to Dr. Wang) from the National Natural Science Foundation of China
文摘The incidence of prostate cancer （PCa） is rising steadily among males in many countries. Serum prostate-specific antigen （PSA） is widely applied to clinical diagnosis and screening of PCa. However, the so-called grey area of PSA levels 4.0-10.0 ng/mL has a low specificity of 25-40% resulting in a high rate of negative biopsy and overtreatment. So in order to treat PCa patients in early stage, there is an urgent need for new biomarkers in PCa diagnosis. The PCA3 gene, a non-coding RNA （ncRNA） that is highly expressed in prostate cancer （PCa） cells, has been identified as a molecular biomarkers to detect PCa, of which PCA3 has already under clinical application. PCA3 is strongly overexpressed in malignant prostate tissue compared to benign or normal adjacent one. Newly, PCA3 is considered to be a promising biomarker in clinical diagnosis and targeted therapy. The diagnostic significance of PCA3, however, is awaiting further researches. Moreover, it has been demonstrated recently that TMPRSS2-ERG gene fusion is identified as the predominant genetic change in patients diagnosed with PCa. Recent study revealed that combination of the PC43 and TMPRSS2-ERG gene fusion test optimizes PCa detection compared with that of single biomarker, which would lead to a considerable reduction of the number of prostate biopsies. In this review, we focused on the potential use of PCA3 and TMPRSS2-ERG gene fusion detection in the diagnosis of PCa.
文摘Purpose: It is now generally accepted that PSA screening identifies many prostate cancers that are low-risk and may not need treatment. PCA3 is a prostate cancer-specific marker with improved diagnostic accuracy when compared with PSA in research studies. It remains unknown whether PCA3 testing can reduce the unnecessary diagnosis and treatment of prostate cancer in routine practice. We evaluated whether the use of PCA3 in clinical practice decreases the number of biopsies being performed in response to PSA testing. Methods: 64 consecutive patients undergoing PCA3 measurement in a single community-based urology practice were analyzed for rates of biopsy performance and prostate cancer detection. Results: Median PSA was 5.0 (range: 0.4 - 38.6) and 50% had undergone prior biopsy without evidence of cancer. Median PCA3 score was 13.6 (range: 1.6 - 133.0) with 14 patients having an elevated PCA3 (>35). Prostate biopsy was avoided in 50 of 64 patients (78%). Of the 11 patients undergoing biopsy for abnormal PCA3, 7 had prostate cancer (64%). At >2-year median follow-up, 39 of the remaining 50 patients (78%) avoided subsequent biopsy. Only 5 prostate cancers were diagnosed during follow-up. Conclusions: When used in routine clinical practice, PCA3 appears to reduce the number of biopsies being performed in response to elevated PSA. Given the increasing interest in strategies to reduce unnecessary prostate cancer diagnosis and treatment, this FDA-approved and widely-available molecular test appears to achieve these goals. Further testing will clarify the role of PCA3 in initial and subsequent prostate cancer screening paradigms.
