尿液中PCA3评分对前列腺癌早期诊断的临床意义

Clinical significance of urinary PCA3 score to diagnose prostate cancer

目的:探讨不同尿液中前列腺癌基因3(PCA3)评分的截断值对可疑前列腺癌患者诊断的应用价值。方法:纳入123例因血清总前列腺特异性抗原(t-PSA)升高和(或)直肠指诊(DRE)异常住院的患者,采集前列腺按摩后的初始尿液标本,使用实时定量PCR检测尿沉渣中PSA及PCA3 mRNA的表达,测定穿刺前尿样PCA3的评分。结合穿刺的病理结果分析不同尿PCA3评分的截断值对诊断前列腺癌的敏感性和特异性(阳性预测和阴性预测)。结果:经穿刺病理结果证实前列腺癌32例,前列腺良性增生91例。当取PCA3评分截断值为35时,可避免52.7%(48例)的患者进行不必要的穿刺,8.8%(8例)的患者被漏诊(被漏诊的患者均是低危前列腺癌);当取PCA3评分截断值为50时,可避免72.5%(66例)的患者进行不必要的穿刺,但13.2%(12例)的患者被漏诊,且2例(16.7%)是中高危前列腺癌。结论:检测可疑前列腺癌患者尿液中PCA3评分可减少不必要的穿刺,且取截断值为35时可获得较高的诊断价值。

Objective：To investigate the value of the different urinary PCA 3 （prostate cancer gene 3） score in diagnosis of suspected prostate cancer.Methods：Samples were obtained from 123 men with increased serum total prostate specific antigen and/or abnormal digital rectal examination before transrectal prostate needle biopsy.The urinary PSA and PCA3 mRNA before biopsy were tested to calculate the associated PCA3 score.Based on pathologic results of different groups,the sensitivity and specificity of prostate cancer were manifested by urinary PCA 3 score.Results：Thirty-two patients were diagnosed with prostate cancer,and 91 were benign prostatic hyperplasia.PCA3 cutoff of 35 could have avoided 52.7% （48 patients） negative biopsies,eventually missing 8.8% （8 patients） with cancers （low risk） ; PCA3 cutoff of 50 would have prevented 72.5% （66 patients） of negative biopsies,missing 13.2% （12 patients）,and 16.7% （2 patients） potentially aggressive.Conclusion：Urinary PCA3 score has the potential to reduce the number of unnecessary prostate biopsies.When PCA3 score is set at 35,urologist can decide when prostate biopsy is given and then obtain a better diagnose of prostate cancer.