EPS Markers in the Early Detection of Prostate Cancer

描述（由申请人提供）：前列腺癌（PCA）是美国男性中最常见的诊断癌症，也是癌症死亡的第二大原因。目前的筛查方式缺乏最佳检测器官局限性和潜在可治愈疾病所需的灵敏度和特异性。众所周知，致癌转化的标志包括一般的染色体不稳定性、胞嘧啶甲基化模式的广泛畸变和端粒酶系统的上调。这导致了最近的报告，其中已确定端粒酶和DNA甲基化状态作为早期检测前列腺癌的候选标记物。我们的实验表明，异位端粒酶表达和甲基化模式的畸变之间也可能存在直接联系。总之，这些发现为使用这些标志物检测肿瘤和肿瘤进展提供了基础。我们的长期目标是利用前列腺液（EPS）作为诊断前列腺癌的非侵入性标本。为此，我们建议验证前列腺癌诊断模型的基础上，同步使用多个标志物的风险分类。基于我们对28例患者的初步研究结果，我们预计年龄、前列腺特异性抗原（PSA）水平、直肠指检（DRE）和EPS端粒酶过表达标志物和局部甲基化变化将为前列腺癌的检测提供高度可靠的检测。我们的假设是，从EPS标本中获得的DNA中的pi类谷胱甘肽-S转移酶基因GSTP 1的甲基化状态将是PCA存在的可靠预测因子，当与这些相同EPS标本上确定的端粒酶组分水平相结合时，并随着患者年龄、PSA水平和DRE信息而增强。我们假设，这种组合将有更高的检测灵敏度，特异性，阳性和阴性预测值比任何单一的检测，包括PSA。使用现在已经在EPS标本中基准化的方法以及临床医生和科学家的凝聚力团队，将从300名患者中收集和分析EPS，作为当地或多机构试验的一部分，这些患者接受TRUSP（前列腺经直肠超声）和活检。

DESCRIPTION (provided by applicant): Prostate cancer (PCA) is the most commonly diagnosed cancer in American males and the second leading cause of cancer deaths. Current screening modalities lack the sensitivity and specificity necessary for the optimal detection of organ confined and potentially curable disease. It is well established that the hallmarks of oncogenic transformation include general chromosome instability, widespread aberrations in cytosine methylation patterning and upregulation of the telomerase system. This has led to recent reports which have identified telomerase and DNA methylation status as candidate markers for the early detection of prostate cancer. Our experiments suggest that there may also be a direct link between ectopic telomerase expression and aberrations in methylation patterning. Taken together, these findings provide the basis for the use of these markers in the detection of tumor and tumor progression. Our long term goal is to exploit expressed prostatic secretion (EPS) as a non-invasive specimen in the diagnosis of prostate cancer. To this end, we propose to validate a model of prostate cancer diagnosis based on the synchronous use of multiple markers of risk classification. Based on our preliminary findings with a series of 28 patients, we expect that age, prostate specific antigen levels (PSA), digital rectal exam (DRE), and EPS markers of telomerase over-expression and local methylation change will provide a highly reliable test for the detection of prostate cancer. Our hypothesis is that methylation status at the pi-class glutathione-S transferase gene GSTP1 in DNA obtained from EPS specimens will be a reliable predictor of the presence of PCA when coupled with telomerase component levels determined on these same EPS specimens and augmented with patient age, PSA levels and DRE information. We hypothesize that this combination will have higher assay sensitivity, specificity, positive and negative predictive values than any single assay alone, including PSA. Using methodology that has now been benchmarked in EPS specimens and a cohesive team of clinicians and scientists, EPS will be collected and analyzed from 300 patients, who, as part of a local or multi-institutional trial, undergo TRUSP (transrectal ultrasound of the prostate) and biopsy.