PSA动力学在前列腺癌的诊断与预后评估中的意义

合适的肿瘤标志物对于恶性肿瘤的早期诊断和预后评估十分重要。自1960年前列腺特异性抗原（PSA）被发现以来,其已成为前列腺癌诊断和预后评估的主要肿瘤标志物。大量的临床实践证明,PSA仍有很多不足之处,如特异性较差。在前列腺增生症和前列腺炎患者的血清中PSA水平也会明显升高。     

血清CA19-9、PSA、FPSA联合检测对前列腺癌临床诊断的价值

前列腺癌是男性常见的肿瘤之一,呈逐年增长趋势,早期诊断、早期治疗是提高生存率的关键。PSA被认为是诊断前列腺癌的特异性肿瘤标志物,但单项检测PSA往往有一定的局限性。随着对肿瘤标志物研究的深入,我们对PSA和FPSA、CA19-9进行联合检测,探讨其在前列腺癌诊断评价上的价值。1     

前列腺癌尿液肿瘤标志物的研究进展

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。     

肿瘤标志物CA19-9、CA242和CEA检测对胰腺癌诊断价值评价

胰腺癌是消化系统最常见恶性肿瘤之一，近年来发病率明显上升，恶性度高，进展快，早期临床表现不典型，不易发现，预后较差。近年来胰腺癌的血清肿瘤标志物研究日益受到重视，但目前尚无单一的血清肿瘤标志物能够准确地诊断胰腺癌，其特异性和敏感性仍不理想，而联合检测血清肿瘤标志物有助于提高胰腺癌的诊断敏感性。我们通过检测血清CA19-9、CA242和CEA水平，初步评价该3项标志物对胰腺癌的诊断价值。     

基因标志物在肿瘤早期诊断中的应用

目前临床上常用的肿瘤标志物其特异性、灵敏度用于肿瘤的早期诊断尚存在诸我不足。随着对肿瘤的发生、发展过程中分子改变的阐明，可能会提供一析的肿瘤标志物。在肿瘤细胞中发生改变的关键分子是细胞癌基因及抑癌基因，这些基因的改变能从那些自肿瘤或癌前病变脱落下来的细胞中检测出来，而为临床癌症的早期诊断、病情判断、预后判断等提供新的肿瘤标物。但这些基因标志物在临床的广泛应用还需对分析方法进行简化及自动化，并需对其     

肿瘤标志物检测的临床应用

探讨肿瘤标志物发生、发展及其检测方法和影响因素，肿瘤标志物在肿瘤的发现、诊断、治疗和预后观察中的应用与研究。     

蛋白指纹图谱技术在临床的应用与国内外研究进展

蛋白质组学（proteomics）就是从整体的角度分析细胞内动态变化的蛋白质组成成份、表达水平与修饰状态，了解蛋白质之间的相互作用与联系。蛋白质组学研究技术主要由分离技术和生物质谱技术为支撑平台，生物信息学为桥梁，对蛋白质表达进行研究。通过肿瘤患者体液中蛋白质组的变化，可以发现特异的肿瘤标志物以达到对肿瘤的早期诊断。医生对于肿瘤的有效处置和治疗直接依赖于他们对肿瘤早期状态的诊断能力。对早期状态的肿瘤蛋白质组学分析为肿瘤早期发生提供了新的了解，并为发现早期诊断的候选标志物提供了可能。通过剖析体液的蛋白指纹图谱的研究为早期发现肿瘤、各种药物及化疗放疗的疗效判断提供力有力的依据。肿瘤的早期发现及治疗监测对于其最后的预防和控制是至关重要的。     

胰腺癌肿瘤标志物的研究进展

肿瘤标志物的研究与应用在肿瘤学中已成为一个引人注目的新领域。研究表明,血清肿瘤标志物的最佳联合检测对于胰腺癌诊断、疗效观察、监测复发或转移、指导治疗及判断预后有重要的意义。国内外大量文献显示联合检测是目前较为理想的肿瘤标志物;肿瘤标志物有望在胰腺癌临床中成为早期诊断、预后判断及调整治疗的工具,CA19-9、CA24-2、K-ras、p53和p16肿瘤标志物具有重要的应用价值。现结合国内外近年来的文献,就肿瘤标志物在胰腺癌诊治中的研究进展作一综述。     

前列腺癌预后因素的探讨

前列腺癌预后的个体差异性显著,正确判断肿瘤的预后是进行有效治疗的前提。本文对Gleason评分、神经内分泌分化、雄激素受体、肿瘤基因/凋亡抑制基因蛋白以及遗传因素、种族因素、饮食习惯等与前列腺癌预后的关系进行探讨,为前列腺癌的个体化治疗提供参考依据。     

胸苷激酶1对恶性肿瘤的早期诊断价值

恶性肿瘤足当今威胁人类健康最主要的疾病之一。目前对肿瘤的诊断主要靠影像学和细胞病理学技术,并且在患者具有明显占位性病变和临床症状后才能确诊。而患暂出现占位病变时已非癌变初期,贻误了最佳治疗时期,因此,寻找对癌症具有早期诊断作用的血清肿瘤标志物更具有临床价值。最新研究发现了一种新的细胞增殖标记物一胸苷激酶1（thymidinekinase1,TKI）,TKI在全身脏器肿瘤的发生、发展及其预后起重要作用。本文对TKI和其他常见肿瘤标志物在恶性肿瘤和癌前病变患者中的检测进行研究,以评价TKI舟肿瘤早期诊断中的价值。报告如下。     

Hormone-refractory prostate cancer: a shifting paradigm in treatment

Prostate cancer, the most common male cancer, affects one in eight American men. Risk factors for the disease include increased age, race, and family history of prostate cancer. To date, surgery, radiation, and hormonal therapy have been the mainstays of treatment. In the past, chemotherapy served only a palliative role for men with prostate cancer and failed to produce a survival advantage or any significant measurable disease response. However, for the first time, docetaxel-based regimens have demonstrated improved survival in men with hormone-refractory prostate cancer in two different, large, phase III studies. Additionally, a number of novel agents are being developed with the hope that treatment for men with hormone-refractory prostate cancer will be improved. Oncology nurses provide critical symptom management strategies as well as education to men with prostate cancer and their partners. Therefore, maintaining current state of the knowledge about best practices and treatment for prostate cancer is crucial. This, in turn, directs efforts to educate patients and family members about treatments and management of side effects.     

The identification and screening of men at high risk for developing prostate cancer

It is estimated that the lifetime risk of being diagnosed with prostate cancer is 1 in 5. The identification of risk factors, including age, African-American ancestry, family history, and possibly diet and environmental factors, has allowed health care professionals the opportunity to identify, screen, and study men at the greatest risk of developing prostate cancer. The risk factors, current screening tools, and the informed consent process for men participating in a prostate cancer screening program are outlined.     

The potential use of cell-free-circulating-tumor DNA as a biomarker for prostate cancer

Introduction: We are yet to identify an accurate, precise and non-invasive biomarker for the detection of prostate cancer. It would undoubtedly be useful to have a reliable and cost-effective biomarker to inform clinical practice, in order to make a non-invasive diagnosis and to predict risk of progression to aggressive prostate cancer. Since the detection of cell-free-circulating-tumor DNA in the body fluids of prostate cancer patients, a number of studies have been conducted to assess diagnostic and/or prognostic information.

Areas covered: In this literature review we evaluate the utility of cell-free-circulating-tumor-DNA for the development of a diagnostic and/or prognostic tool for prostate cancer. In addition, we identify potential areas for future research. Results from both quantitative and qualitative studies are presented.

Expert commentary: Evidence for the suitability of a panel of DNA methylation markers for the non-invasive diagnosis of prostate cancer is strong. This panel would likely include the assessment of methylation status in gene promoter regions within the EDNR, GSTP1 and MDR genes. TIMP3 and APC show potential as diagnostic markers and should be further researched. Similarly, quantitation of cell-free-circulating-tumor-DNA in blood and urine requires further investigation.     

Interest in genetic prostate cancer susceptibility testing among african American men

Six regions for prostate cancer genes have been identified, and it is anticipated that prostate cancer susceptibility testing will be available in the future. This correlational study identified predictors for interest in prostate cancer susceptibility testing among African American men. Participants were 320 African American men from the African American Hereditary Prostate Cancer Study and the South Carolina Prostate Cancer Education and Screening Study participated. Two questions measured interest in genetic prostate cancer susceptibility testing and family history of prostate cancer. Chi-square analyses by family history as well as demographics (age, education, marital status) were performed. Most of the men (277 [87%]) indicated an interest in genetic prostate cancer susceptibility testing. Interest in undergoing testing did not vary by family history, age, or education. Marital status was the only significant demographic predictor. Men who were married were significantly more likely to respond with a "yes" to interest in prostate cancer susceptibility testing than were men who were not married. The high "yes" response rate and the men's confusion between the genetic prostate cancer susceptibility testing and prostate cancer screening highlight the need for public education once prostate cancer genes are identified and available for public testing.     

Risk factors and current chemoprevention studies in prostate cancer

There are no established risk factors for prostate cancer other than age, ethnic group, and family history. For dietary factors, the WCRF/AICR reported that diets high in vegetables were possibly protective, and that regular consumption of red meat, fat, saturated/animal fat, and milk and any products possibly increased risk. Among nutritional factors, a protective effect of lycopene, vitamin E, selenium, and perhaps fish oil and phytoestrogens appear particularly promising, although no definite answers have yet emerged. Although hormonal influences are biologically plausible, observational studies of androgen have not produced consistent results. While, insulin-like growth factor 1 could be a risk factor. Based on these evidences, several chemoprevention trials were launched using 5-alpha reductase inhibitor, selenium, vitamin E and so on.     

Reducing prostate cancer morbidity and mortality in African American men: issues and challenges

Prostate cancer is the most commonly diagnosed cancer in men in the United States. It disproportionately affects African American men when compared to other ethnic groups. African American men are two to three times more likely to die of prostate cancer than white men. The reasons for the disparity remain unclear, but several factors may be involved, such as age, race, nationality, nutrition, exercise, and family history of cancer. Detection of prostate cancer in high-risk African Americans is important but continues to be controversial. This article reviews the current issues and challenges regarding prostate cancer in African American men. Nurses play a vital role in the health care and education of patients; therefore, they must be aware of the issues.     

Human tissue kallikreins: a family of new cancer biomarkers

Kallikreins are a subgroup of the serine protease enzyme family. Until recently, it was thought that the human kallikrein gene family contained only three members. In the past 3 years, the entire human kallikrein gene locus was discovered and found to contain 15 kallikrein genes. Kallikreins are expressed in many tissues, including steroid hormone-producing or hormone-dependent tissues such as the prostate, breast, ovary, and testis. Most, if not all, kallikreins are regulated by steroid hormones in cancer cell lines. There is strong but circumstantial evidence linking kallikreins and cancer. Prostate-specific antigen (PSA; hK3) and, more recently, human glandular kallikrein (hK2) are widely used tumor markers for prostate cancer. Three other kallikreins, hK6, hK10, and hK11, are emerging new serum biomarkers for ovarian and prostate cancer diagnosis and prognosis. Several other kallikreins are differentially expressed at both the mRNA and protein levels in various endocrine-related malignancies, and they have prognostic value. The coexpression of many kallikreins in the same tissues (healthy and malignant) points to the possible involvement of kallikreins in cascade enzymatic pathways. In addition to their diagnostic/prognostic potential, kallikreins may also emerge as attractive targets for therapeutics.     

Hereditary prostate cancer

Familial prostate cancer patients are sometimes encountered. Hereditary prostate cancer is a more specific form of familial prostate cancer that is inherited by a susceptibility gene consistent with Mendelian inheritance. Early age at onset is the most important characteristic. No clear differences in either stage, grade or prognosis have been found between hereditary and sporadic prostate cancer. No susceptibility genes have been isolated yet, but several genes may exist. In Japan, doctors are not generally aware of hereditary and familial prostate cancer. Family history is one of the most important risk factors of prostate cancer. We should make an effort to find prostate cancer patients at an early stage in the high risk families.     

PS1-07: PSA Test Use in Primary Care

Background/Aims Some professional organizations advocate for PSA testing to screen for prostate cancer while others recommend against it. Regardless of position, each advocates for consideration of individual risk factors and for patients to consult with their physician when deciding. We describe men's use of PSA testing around the time of a periodic health examination (PHE), whether test use varies by patient risk factor status, and the extent to which PSA testing occurs following patient-physician discussion of PSA testing, prostate cancer, or both. Methods Physician and patient subjects were enrolled in an observational study of patient-physician decision making in primary care. Physicians were salaried, general internal and family medicine physicians. Patients were insured, aged 50-80 years, without a history of prostate cancer, and due for colorectal cancer screening at the time of an audio-recorded office visit between 2007-2009. Office visit recordings were joined with data from pre-visit patient surveys and automated laboratory data for the 6 prior and 8 subsequent weeks. Content of patient-physician discussions was coded with a structured coding worksheet (mean Cohen's Kappa = 0.77). Generalized estimating equations were used to evaluate associations among patient-physician screening-related talk, patient risk factors, and PSA use. Results Among N=161 study-eligible men, just over half (53%) presented with at least one risk factor: 11.2% family history; 29.2% aged 65+; and 21.2% black. Eighty-one percent used PSA testing around the time of their PHE (8.3% prior and 72.7% subsequent to visit). Test use did not differ significantly by risk factor status: family history, 94.4% vs. no family history, 79.4%, (p=0.13); aged 65+, 85.1% vs. aged <65, 79.8% (p=0.39); and blacks, 76.5% vs. whites, 82.7%(p=0.49). Prostate cancer, PSA testing, or both was mentioned during 82% of visits: 34.8% mentioned prostate cancer and 79.5% PSA testing. Among men tested subsequent to visit, these percents were 92.9%, 35.0% and 89.3%, respectively. Discussion PSA testing is common among men who schedule a PHE, regardless of risk factor status. Furthermore, 7% of men who receive PSA testing subsequent to their PHE, do so in absence of any mention of prostate cancer or PSA screening during the visit.