Liquid biomarkers in active surveillance
Liquid biomarkers in active surveillance
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DOI：
10.1007/s00345-021-03609-5
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发表时间：
2021-02-15
影响因子：
3.4
通讯作者：
Dall'Era, Marc
中科院分区：
文献类型：
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作者：
Dall'Era, Marc
在过去的二十年中，新的前列腺癌检测和风险预测的生物标志物已经可用于临床应用。虽然基于组织的基因表达测定提供了诊断后的分子风险评估，但一些基于血清和尿液的“液体”生物标志物可用于活检前设置，这也可能在主动监测（AS）中发挥作用。方法利用PubMed （PubMed .ncbi.nlm.nih.gov）检索所有描述血液、尿液或精液中可识别的前列腺癌生物标志物的相关原始出版物。参考研究必须有明确的患者纳入标准和生物标志物的描述。纳入的研究调查了液体生物标志物在主动监测前列腺癌患者的选择或监测中的效用。结果PSA是诊断和治疗前列腺癌最常见、最容易获得的生物标志物。当代AS指南在选择男性采用这种方法时，除了考虑其他临床因素外，还考虑诊断性PSA水平，大多数建议初始PSA应低于10 ng/ml。血清PSA变化与AS的预后相关，但不够敏感，因此促使男性单独进行二次治疗。PSA衍生产品包括前列腺健康指数（phi）和4K评分可以预测更高级别的癌症，并可能有助于定制重复前列腺活检策略，但在常规临床应用之前需要进一步的数据。一些基于尿液的生物标志物，包括PCA3和TMPRSS2:ERG水平也在AS环境中进行了研究。结论：多种基于血清和尿液的液体生物标志物可用于前列腺癌患者。对于AS，血清PSA部分用于患者选择以及监测疾病随时间的变化。将PSA动力学与其他临床特征相结合的模型可能有助于定制监测策略，以减少疾病负担和医疗保健成本。几种新型液体生物标志物显示出前景，并可能最终应用于前列腺癌监测。
Purpose In the past two decades, new biomarkers for prostate cancer detection and risk prediction have become available for clinical use. While tissue-based gene expression assays offer molecular risk assessment after diagnoses, several serum- and urine-based 'liquid' biomarkers are available for the pre-biopsy setting which may also play a role for active surveillance (AS). Methods The medical literature was queried utilizing PubMed (pubmed.ncbi.nlm.nih.gov) for all relevant original publications describing prostate cancer biomarkers that can be identified in the blood, urine, or semen. Referenced studies must have defined patient inclusion criteria and descriptions of the biomarkers. Included studies investigated the utility of liquid biomarkers for selection or monitoring of men with prostate cancer for active surveillance. Results PSA is the most common and readily available biomarker for prostate cancer diagnosis and treatment. Contemporary AS guidelines consider diagnostic PSA level in addition to other clinical factors when selecting men for this approach, with most recommending that initial PSA should be under 10 ng/ml. Serum PSA changes are associated with outcomes on AS but are not adequately sensitive so drive men to secondary treatment in isolation. PSA derivates including the Prostate Health Index (phi) and the 4K Score can predict higher grade cancer and may help tailor repeat prostate biopsy strategies, but further data are needed prior to routine clinic use. Several urine-based biomarkers including PCA3 and TMPRSS2:ERG levels have also been studied in the AS setting. Conclusions Multiple serum- and urine-based liquid biomarkers are available for use in men with prostate cancer. For AS, serum PSA is utilized in part for patient selection as well as to monitor disease over time. Models that incorporate PSA kinetics with other clinical characteristics may help tailor surveillance strategies to reduce disease burden and health care costs over time. Several novel liquid biomarkers demonstrate promise and may eventually have applications for prostate cancer surveillance as well.