A panel of kallikrein markers can predict outcome of prostate biopsy following clinical work-up: an independent validation study from the European Randomized Study of Prostate Cancer screening, France.
A panel of kallikrein markers can predict outcome of prostate biopsy following clinical work-up: an independent validation study from the European Randomized Study of Prostate Cancer screening, France.
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DOI：
10.1186/1471-2407-10-635
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发表时间：
2010-11-22
期刊：
影响因子：
3.8
通讯作者：
Vickers A
中科院分区：
文献类型：
--
作者：
Benchikh A;Savage C;Cronin A;Salama G;Villers A;Lilja H;Vickers A
我们之前已经证明，一组激肽释放酶标志物-总前列腺特异性抗原（PSA），游离PSA，完整PSA和人激肽释放酶相关肽酶2（hK 2）-可以预测PSA升高的男性前列腺活检的结果。在这里，我们调查的属性，我们的面板在男性受临床检查活检前。我们将先前发表的基于激肽释放酶组的预测模型应用于262名PSA升高（≥ 3 ng/ml）后接受前列腺活检的男性，并在法国前列腺癌筛查的欧洲随机研究期间进行进一步的临床检查。将该模型的预测准确性与PSA、年龄和直肠指检（DRE）的“基础”模型进行比较。83名（32%）男性在活检时患有前列腺癌，其中45名（54%）患有高级别疾病（Gleason评分7或更高）。我们的模型在预测癌症（曲线下面积[AUC]从0.63提高到0.78）或高级别癌症（AUC从0.77增加到0.87）方面的准确性显著高于基础模型。使用决策规则对模型中具有20%或更高癌症风险的患者进行活检，将使活检数量减少近一半。对于每1000名PSA升高且有活检临床指征的男性，该模型将建议61名癌症男性不进行活检，其中大多数（约80%）在诊断时患有低分期和低级别疾病。在这项独立的验证研究中，该模型高度预测男性前列腺癌，对他们来说，活检的决定是基于PSA升高和临床检查。使用这种模型将减少大量的活检，同时遗漏很少的癌症。
We have previously shown that a panel of kallikrein markers - total prostate-specific antigen (PSA), free PSA, intact PSA and human kallikrein-related peptidase 2 (hK2) - can predict the outcome of prostate biopsy in men with elevated PSA. Here we investigate the properties of our panel in men subject to clinical work-up before biopsy. We applied a previously published predictive model based on the kallikrein panel to 262 men undergoing prostate biopsy following an elevated PSA (≥ 3 ng/ml) and further clinical work-up during the European Randomized Study of Prostate Cancer screening, France. The predictive accuracy of the model was compared to a "base" model of PSA, age and digital rectal exam (DRE). 83 (32%) men had prostate cancer on biopsy of whom 45 (54%) had high grade disease (Gleason score 7 or higher). Our model had significantly higher accuracy than the base model in predicting cancer (area-under-the-curve [AUC] improved from 0.63 to 0.78) or high-grade cancer (AUC increased from 0.77 to 0.87). Using a decision rule to biopsy those with a 20% or higher risk of cancer from the model would reduce the number of biopsies by nearly half. For every 1000 men with elevated PSA and clinical indication for biopsy, the model would recommend against biopsy in 61 men with cancer, the majority (≈80%) of whom would have low stage and low grade disease at diagnosis. In this independent validation study, the model was highly predictive of prostate cancer in men for whom the decision to biopsy is based on both elevated PSA and clinical work-up. Use of this model would reduce a large number of biopsies while missing few cancers.
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