Prognostic value of serum markers for prostate cancer
Prognostic value of serum markers for prostate cancer
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DOI：
10.1080/03008880510030941
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发表时间：
2005-05-01
影响因子：
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通讯作者：
Ekman, P
中科院分区：
文献类型：
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作者：
Stenman, UH;Abrahamsson, PA;Ekman, P
前列腺癌的发病率在过去10 - 15年中急剧增加，现在是发达国家男性中最常见的癌症。增加的主要原因是越来越多地使用机会性筛查或基于使用血清中前列腺特异性抗原（PSA）检测的病例发现。通过这种方法，前列腺癌在出现症状前5 - 10年被发现，平均在导致患者死亡前17年被发现。虽然这导致在潜在可治愈阶段检测到前列腺癌，但它也导致大量过度诊断，即在没有筛查的情况下检测到临床上不会出现的癌症。因此，一个主要的挑战是确定需要治疗的病例，同时避免诊断那些不会从诊断中受益并且只会遭受作为癌症患者的耻辱的患者。有一个可以预测哪些患者需要诊断，哪些不需要诊断的预后标志物将是有用的。理想情况下，应该可以使用非侵入性技术，即通过血清或尿液测试来测量这些标志物。由于PSA对前列腺癌的早期诊断和监测非常有用，因此被认为是任何肿瘤最有价值的标志物。虽然PSA的预后价值有限，但游离PSA比例的测量提高了侵袭性疾病患者的识别。此外，血清PSA的增加速率反映了肿瘤生长速率和预后，但由于血清PSA的生理变化，PSA增加速率的可靠估计需要至少2年的随访。基于在逻辑回归和神经网络中结合使用游离PSA和总PSA以及前列腺体积的算法可以提高前列腺癌的诊断准确性，并且PSA和其他新标志物的次要亚组分的测定可以提供额外的预后信息。神经内分泌分化标志物可用于监测雄激素非依赖性疾病，各种骨标志物可用于转移性疾病患者。
The incidence of prostate cancer has increased dramatically during the last 10-15 years and it is now the commonest cancer in males in developed countries. The increase is mainly caused by the increasing use of opportunistic screening or case-finding based on the use of prostate-specific antigen (PSA) testing in serum. With this approach, prostate cancer is detected 5-10 years before giving rise to symptoms and on average 17 years before causing the death of the patient. While this has led to detection of prostate cancer at a potentially curable stage, it has also led to substantial overdiagnosis, i.e. detection of cancers that would not surface clinically in the absence of screening. A major challenge is thus to identify the cases that need to be treated while avoiding diagnosing patients who will not benefit from being diagnosed and who will only suffer from the stigma of being a cancer patient. It would be useful to have prognostic markers that could predict which patients need to be diagnosed and which do not. Ideally, it should be possible to measure these markers using non-invasive techniques, i.e. by means of serum or urine tests. As it is very useful for both early diagnosis and monitoring of prostate cancer, PSA is considered the most valuable marker available for any tumor. Although the prognostic value of PSA is limited, measurement of the proportion of free PSA has improved the identification of patients with aggressive disease. Furthermore, the rate of increase in serum PSA reflects tumor growth rate and prognosis but, due to substantial physiological variation in serum PSA, reliable estimation of the rate of PSA increase requires follow-up for at least 2 years. Algorithms based on the combined use of free and total PSA and prostate volume in logistic regression and neural networks can improve the diagnostic accuracy for prostate cancer, and assays for minor subfractions of PSA and other new markers may provide additional prognostic information. Markers of neuroendocrine differentiation are useful for the monitoring of androgen-independent disease and various bone markers are useful in patients with metastatic disease.