Prostate Health Index (Phi) and Prostate Cancer Antigen 3 (PCA3) Significantly Improve Prostate Cancer Detection at Initial Biopsy in a Total PSA Range of 2-10 ng/ml
Prostate Health Index (Phi) and Prostate Cancer Antigen 3 (PCA3) Significantly Improve Prostate Cancer Detection at Initial Biopsy in a Total PSA Range of 2-10 ng/ml
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DOI：
10.1371/journal.pone.0067687
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发表时间：
2013-07-04
期刊：
影响因子：
3.7
通讯作者：
Terracciano, Daniela
中科院分区：
文献类型：
--
作者：
Ferro, Matteo;Bruzzese, Dario;Terracciano, Daniela
已经做出了许多努力来减少前列腺特异性抗原（PSA）的过度诊断和过度治疗。为此，前列腺健康指数（Phi）和前列腺癌抗原3（PCA 3）已被提议作为新的更特异性的生物标志物。我们评估了在总PSA范围为2-10 ng/ml的男性中，在初始前列腺活检时phi和PCA 3识别前列腺癌（PCa）的能力。在300例首次前列腺活检患者中评价phi和PCA 3的性能。ROC曲线分析检验phi和PCA 3预测PCa的准确性（AUC）。决策曲线分析（DCA）用于比较两种生物标志物的临床获益。我们发现phi（0.77）的AUC值与%p2PSA（0.76）和PCA 3（0.73）的AUC值相当，在成对比较中无显著差异（%p2PSA vs phi p = 0.673，%p2PSA vs PCA 3 p = 0.417和phi vs PCA 3 p = 0.247）。这三种生物标志物显著优于fPSA（AUC = 0.60）、%fPSA（AUC = 0.62）和p2PSA（AUC = 0.63）。在DCA中，phi和PCA 3表现出非常接近的净效益曲线，直到阈值概率为25%，然后phi指数显示出比PCA 3更高的净效益。多变量分析显示，在基础多变量模型（年龄、PSA、%fPSA、DRE、前列腺体积）中添加phi和PCA 3可提高预测准确性，而无模型改善单一生物标志物性能。最后，我们发现，与主动监测（AS）兼容的癌症受试者具有显著较低的phi和PCA 3值（分别为p < 0.001和p = 0.01）。总之，phi和PCA 3 β均增加了在初始活检时预测总PSA范围2-10 ng/ml的PCa存在的准确性，优于目前使用的%fPSA。
Many efforts to reduce prostate specific antigen (PSA) overdiagnosis and overtreatment have been made. To this aim, Prostate Health Index (Phi) and Prostate Cancer Antigen 3 (PCA3) have been proposed as new more specific biomarkers. We evaluated the ability of phi and PCA3 to identify prostate cancer (PCa) at initial prostate biopsy in men with total PSA range of 2-10 ng/ml. The performance of phi and PCA3 were evaluated in 300 patients undergoing first prostate biopsy. ROC curve analyses tested the accuracy (AUC) of phi and PCA3 in predicting PCa. Decision curve analyses (DCA) were used to compare the clinical benefit of the two biomarkers. We found that the AUC value of phi (0.77) was comparable to those of %p2PSA (0.76) and PCA3 (0.73) with no significant differences in pairwise comparison (%p2PSA vs phi p = 0.673, %p2PSA vs. PCA3 p = 0.417 and phi vs. PCA3 p = 0.247). These three biomarkers significantly outperformed fPSA (AUC = 0.60), %fPSA (AUC = 0.62) and p2PSA (AUC = 0.63). At DCA, phi and PCA3 exhibited a very close net benefit profile until the threshold probability of 25%, then phi index showed higher net benefit than PCA3. Multivariable analysis showed that the addition of phi and PCA3 to the base multivariable model (age, PSA, %fPSA, DRE, prostate volume) increased predictive accuracy, whereas no model improved single biomarker performance. Finally we showed that subjects with active surveillance (AS) compatible cancer had significantly lower phi and PCA3 values (p < 0.001 and p = 0.01, respectively). In conclusion, both phi and PCA3 comparably increase the accuracy in predicting the presence of PCa in total PSA range 2-10 ng/ml at initial biopsy, outperforming currently used %fPSA.