Reducing Unnecessary Biopsy During Prostate Cancer Screening Using a Four-Kallikrein Panel: An Independent Replication
Reducing Unnecessary Biopsy During Prostate Cancer Screening Using a Four-Kallikrein Panel: An Independent Replication
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DOI：
10.1200/jco.2009.24.1968
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发表时间：
2010-05-20
影响因子：
45.3
通讯作者：
Lilja, Hans
中科院分区：
文献类型：
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作者：
Vickers, Andrew;Cronin, Angel;Lilja, Hans
目的我们以前报道过，血液中的四种激肽释放酶形式-总的、游离的和完整的前列腺特异性抗原（PSA）和激肽释放酶相关肽酶2（hK 2）-可以减少以前未筛查的总PSA升高的男性不必要的活检。我们的目的是复制我们的研究结果在一个大的，独立的，有代表性的，以人口为基础的coherent.Patients和MethodsThe研究队列包括2,914以前未筛选的男性进行活检，由于PSA升高（>= 3 ng/mL），在欧洲随机研究筛选前列腺癌，鹿特丹，807前列腺癌（28%）检测。队列按1：3随机分为训练集和验证集。激肽释放酶标志物的水平进行了比较与活检outcome.ResultsAddition游离PSA，完整的PSA，和hK 2的总PSA和年龄的模型，提高了曲线下面积从0.64至0.76和0.70至0.78模型没有和数字直肠检查结果，分别（P <0.001）。将该小组应用于1,000名PSA升高的男性将减少513次活检，并错过177例低度癌症中的54例和100例高度癌症中的12例。结果是强大的敏感性analysis.ConclusionWe已经复制了我们以前发表的发现，一个面板的四个激肽释放酶可以预测前列腺癌的PSA升高的男性活检的结果。使用该面板将显著降低活检率。一小部分男性癌症患者会被建议不要立即进行活检，但这些人主要是低阶段，低级别的疾病。
PurposeWe previously reported that a panel of four kallikrein forms in blood-total, free, and intact prostate-specific antigen (PSA) and kallikrein-related peptidase 2 (hK2)-can reduce unnecessary biopsy in previously unscreened men with elevated total PSA. We aimed to replicate our findings in a large, independent, representative, population-based cohort.Patients and MethodsThe study cohort included 2,914 previously unscreened men undergoing biopsy as a result of elevated PSA (>= 3 ng/mL) in the European Randomized Study of Screening for Prostate Cancer, Rotterdam, with 807 prostate cancers (28%) detected. The cohort was randomly divided 1:3 into a training and validation set. Levels of kallikrein markers were compared with biopsy outcome.ResultsAddition of free PSA, intact PSA, and hK2 to a model containing total PSA and age improved the area under the curve from 0.64 to 0.76 and 0.70 to 0.78 for models without and with digital rectal examination results, respectively (P < .001 for both). Application of the panel to 1,000 men with elevated PSA would reduce the number of biopsies by 513 and miss 54 of 177 low-grade cancers and 12 of 100 high-grade cancers. Findings were robust to sensitivity analysis.ConclusionWe have replicated our previously published finding that a panel of four kallikreins can predict the result of biopsy for prostate cancer in men with elevated PSA. Use of this panel would dramatically reduce biopsy rates. A small number of men with cancer would be advised against immediate biopsy, but these men would have predominately low-stage, low-grade disease.