前列腺癌尿液肿瘤标志物的研究进展

Advances in Urinary Tumor Markers of Prostate Cancer

前列腺癌是男性生殖系统最常见的恶性肿瘤之一,也是导致男性癌症死亡的第五大原因,早期诊治可改善患者预后。目前,前列腺癌的诊断主要依赖于直肠指诊或血清前列腺特异性抗原(prostate specific antigen,PSA)检测后前列腺穿刺活检确诊。但血清PSA检测特异性较低,不能有效区分惰性前列腺癌与具有临床意义的前列腺癌,导致不必要的活检及过度治疗,因此迫切需要更具特异性的肿瘤标志物。前列腺癌细胞可将肿瘤标志物释放至前列腺液中,而后进入尿液,因此通过尿液即可检测前列腺癌肿瘤标志物。近年来,已开发了多种基于尿液及其外泌体的肿瘤标志物,如PSA、PCA3、MALAT1及微RNA等,本文将阐述尿液肿瘤标志物在前列腺癌诊断中的研究进展。

Prostate cancer(PCa)is currently the second most common cancer in men worldwide.The current gold standard for diagnosing PCa relies on ultrasound-guided systematic core needle biopsy after detection changes in a digital rectal examination and elevated prostate-specific antigen(PSA)level in the blood serum.Yet,serum PSA cannot reliably discriminate between benign pathologies and clinically significant forms of PCa.A common problem caused by the low specificity of this marker is over diagnosis,which leads to unnecessary biopsies and over treatment.This may be associated with various treatment complications(such as bleeding or infection)and generate unnecessary costs.Therefore,there is an urgent need for more specific and predictive biomarkers to effectively discriminate between aggressive and nonaggressive tumors and to avoid unnecessary prostate biopsies.Biomarkers derived from prostate cancer cells are released into prostatic fluids and then into urine.Urine after manipulation of the prostate is enriched with PCa biomarkers,including prostate cancer cells,DNAs,RNAs,proteins and other small molecules.In recent years,several non-invasive,costeffective,high-accuracy urinary diagnostic biomarkers such as PSA,PCA3,MALAT1 and microRNA have been developed.This article reviews the biomarkers for the non-invasive testing of PCa in urine.