PCA3: A molecular urine assay for predicting prostate biopsy outcome
PCA3: A molecular urine assay for predicting prostate biopsy outcome
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DOI：
10.1016/j.juro.2007.11.038
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发表时间：
2008-04-01
影响因子：
6.6
通讯作者：
Groskopf, Jack
中科院分区：
文献类型：
--
作者：
Deras, Ina L.;Aubin, Sheila M. J.;Groskopf, Jack
目的：PCA3（一种在前列腺癌细胞中高度过度表达的 mRNA）的尿液检测已显示出作为这种常见恶性肿瘤的诊断测试的有用性。我们进一步表征了不同男性群体中的 PCA3 表现，并确定 PCA3 评分是否可以与其他临床信息协同作用来预测活检结果。 材料和方法：在前列腺活检前立即对 570 名男性进行标准化直肠指检后前瞻性收集尿液。对尿液 PCA3 mRNA 水平进行定量，然后将其标准化为前列腺来源的 RNA 量，以生成 PCA3 评分。结果：确定的活检阳性男性百分比随 PCA3 评分直接增加。第一个阴性活检组与之前的阴性活检组的 PCA3 检测性能相当，ROC 曲线下面积分别为 0.70 和 0.68。与血清前列腺特异性抗原不同，PCA3 评分不会随着前列腺体积的增加而增加。 PCA3 测定的灵敏度和特异性在血清前列腺特异性抗原低于 4、4 至 10 和高于 10 ng/ml 时相当。使用 PCA3、血清前列腺特异性抗原、前列腺体积和直肠指检结果的逻辑回归算法将 AUC 从单独 PCA3 的 0.69 增加到 0.75 (p = 0.0002)。结论：PCA3 独立于前列腺体积、血清前列腺特异性抗原水平和先前活检的数量。定量 PCA3 评分与活检阳性的概率相关。 Logistic 回归结果表明，PCA3 评分可以合并到列线图中，以改进对活检结果的预测。这项研究的结果进一步证明 PCA3 是当前前列腺癌诊断方法的有用辅助手段。
Purpose: A urinary assay for PCA3, an mRNA that is highly over expressed in prostate cancer cells, has shown usefulness as a diagnostic test for this common malignancy. We further characterized PCA3 performance in different groups of men and determined whether the PCA3 score could synergize with other clinical information to predict biopsy outcome.Materials and Methods: Prospectively urine was collected following standardized digital rectal examination in 570 men immediately before prostate biopsy. Urinary PCA3 mRNA levels were quantified and then normalized to the amount of prostate derived RNA to generate a PCA3 score.Results: The percent of biopsy positive men identified increased directly with the PCA3 score. PCA3 assay performance was equivalent in the first vs previous negative biopsy groups with an area under the ROC curve of 0.70 and 0.68, respectively. Unlike serum prostate specific antigen the PCA3 score did not increase with prostate volume. PCA3 assay sensitivity and specificity were equivalent at serum prostate specific antigen less than 4, 4 to 10 and more than 10 ng/ml. A logistic regression algorithm using PCA3, serum prostate specific antigen, prostate volume and digital rectal examination result increased the AUC from 0.69 for PCA3 alone to 0.75 (p = 0.0002).Conclusions: PCA3 is independent of prostate volume, serum prostate specific antigen level and the number of prior biopsies. The quantitative PCA3 score correlated with the probability of positive biopsy. Logistic regression results suggest that the PCA3 score could be incorporated into a nomogram for improved prediction of biopsy outcome. The results of this study provide further evidence that PCA3 is a useful adjunct to current methods for prostate cancer diagnosis.