Hepsin基因在前列腺癌中的研究进展

Hepsin是最近筛查发现的在前列腺癌中高表达的基因,其编码一种Ⅱ型跨膜丝氨酸蛋白酶,有可能成为前列腺癌的一个新的肿瘤标志物和治疗靶点。本文就Hepsin基因在前列腺癌中的研究作一综述。     

前列腺癌早期诊断标志物的研究进展

前列腺癌是最常见的男性恶性肿瘤之一。近年来,前列腺癌在我国的发病率呈逐年上升趋势。前列腺癌的早期诊断对指导前列腺癌穿刺、治疗方式以及疾病预后具有直接的影响。目前,前列腺癌筛查的最常用标志物前列腺特异抗原并不是肿瘤特异性标志物,人们发现其用于前列腺癌早期诊断的特异性并不理想,导致了较多不必要的穿刺。因此,获取与前列腺癌高度相关性的肿瘤标志物是现今的研究热点。近年来新发现的长链非编码RNA、单核苷酸多态性及融合基因等分子已被证实与肿瘤具有相关性,可明显提高前列腺癌的诊断效能。本文现就前列腺特异抗原和新发现的几种相关肿瘤标志物在前列腺癌诊断方面的研究进展做一综述。     

主动监测在局限性低危前列腺癌中的应用

前列腺特异性抗原筛查前列腺癌的副作用是过度诊断和过度治疗。主动监测作为有效的低危局限性前列腺癌的初始治疗选择,已经取得了较好的肿瘤学疗效,并发症比例也显著下降,但这一治疗策略的充分应用仍面临许多障碍,适应证、监测流程及积极干预指征的制定仍需完善。新的生物标志物及影像学技术的综合运用将有助于选择主动监测的适合人群并及时发现疾病的进展。主动监测体现了前列腺癌治疗思维模式的转移,它将通过改善大规模前列腺癌筛查效益分析比、减少过度治疗现象而改变治疗癌症的前景。     

肿瘤标志物在前列腺癌中的研究进展

前列腺癌是男性泌尿生殖系统最常见的恶性肿瘤之一.近年来随着我国人民生活水平的提高及饮食结构的改变,前列腺癌在我国的发病率呈每年不断上升的趋势.对前列腺癌肿瘤标志物的研究日益受到关注,本文总结了近年来前列腺癌组织中几种标志物的研究方法与鉴别效果,并对其潜在临床应用进行了简要的评价,以此进一步加强前列腺癌肿瘤标志物的研究.     

前列腺癌筛查随机试验带给我们什么？

上世纪80年代末,前列腺特异抗原（PSA）在前列腺癌筛查中的应用掀起了全球尤其是发达国家的前列腺癌发病高潮。然而,直到2009年第一篇关于筛查效果的有说服力的随机对照研究文章才被发表。欧洲前列腺癌筛查随机对照研究中,筛查组中死于前列腺癌的患者的比例比对照组低将近20％。绝对差异只有0．7／1000,这意味着需要检查1400人以上才能预防一个因前列腺癌漏查而导致的死亡。该项筛查也使被诊断为前列腺癌的风险增加了70％。美国前列腺癌、肺癌、大肠癌和卵巢癌筛查试验结果发现筛查并没有提高有关患者的生存比例。根据该结果并不能下什么结论,因为有相当比例的研究对象以前接受过PSA筛查,对照组中超过一半的研究对象进行过PsA测试,随访时间相对较短,只有不到100名患者死于前列腺癌。与筛查带来的好处相对的是过度诊断导致的风险（发现将来不会出现临床症状的癌症迹象）和治疗并发症带来的风险,包括泌尿系统,性功能和肠道功能障碍。前列腺癌筛查取得的成果可能受益于改良的生物标志物,它们可以更容易地识别临床上重要的癌症和／或提供预后信息。虽然现有化学制剂颇受争议,但癌症控制可能还是需要化学预防。同时,对于是否需要进行前列腺癌筛查,患者仍需要帮助以作出明智的决策。     

PI3K/Akt途径在前列腺癌中的治疗前景

磷脂酰肌醇-3羟基激酶/蛋白激酶B(PI3K/Akt)信号通路是肿瘤、炎症等发生发展过程中一条重要的信号通路。研究发现,在许多肿瘤组织中,PI3K/Akt信号通路的活化和过度表达与肿瘤的发生发展密切相关。在前列腺癌中,这种途径的激活似乎是许多侵袭性前列腺癌的特征。该途径的生物标志物将其与疾病进展风险相关联。本文回顾了PI3K/Akt途径的共同靶向方法的基本原理和相关性,以期通过更好地了解前列腺癌中PI3K/Akt途径的生物学特征,相关生物标志物和联合治疗来优化该靶向途径,从而改善侵袭性前列腺癌患者的结局。     

前列腺癌标志物的研究进展

前列腺癌生物学行为具有特殊性 ,其早期诊断、鉴别诊断、治疗及预后评价的需要 ,促进了前列腺癌肿瘤标志物研究的迅猛发展。本文综述了目前常用的及新近发现的有价值的前列腺癌标志物     

前列腺癌生物标志物研究进展

前列腺癌是危害男性健康的恶性疾病,现有检测方法仍不能满足准确诊断前列腺癌的要求,因此致力于鉴定新的灵敏性和特异性更高的生物标志物的研究仍在开展。新技术的应用加速并拓宽了前列腺癌诊断技术的发展,蛋白质组模式分析作为一种有效的诊断方法已经逐渐显现出来,为前列腺癌的个体化评价和治疗带来了希望。     

前列腺癌诊断标志物研究进展

前列腺癌是严重危害男性健康的肿瘤,有较高的恶性倾向,在我国发病率逐年上升。前列腺癌患者生存和预后的关键在于早期诊断与有效的治疗。目前临床以前列腺特异性抗原(PSA)及穿刺活检为主要诊断方法,但存在特异度不高、过度穿刺活检等问题。寻找高特异度、高敏感度的前列腺癌诊断标志物是目前研究热点。近年研究发现了长链非编码RNA(lncRNA)、TMPRSS2:ERG融合基因等许多新的肿瘤诊断标志物,对PSA及前列腺癌基因3(PCA3)等诊断标志物的研究也有新的进展,本文针对前列腺癌诊断标志物研究进展作一综述。     

前列腺癌生物标志物研究进展

前列腺癌是危害男性健康的恶性疾病，现有检测方法仍不能满足准确诊断前列腺癌的要求，因此致力于鉴定新的灵敏性和特异性更高的生物标志物的研究仍在开展。新技术的应用加速并拓宽了前列腺癌诊断技术的发展，蛋白质组模式分析作为一种有效的诊断方法已经逐渐显现出来，为前列腺癌的个体化评价和治疗带来了希望。     

早期前列腺癌抗原-2在前列腺癌早期诊治中的应用

PSA在前列腺癌患者筛选、诊治、随访应用中的局限性越来越被临床所证实,人们也在不断寻找新的前列腺癌的标志物,早期前列腺癌抗原-2(EPCA-2)的发现为人们提供了这一依据,具有潜在的临床应用价值,本文对EPCA-2在前列腺癌的早期诊治中的应用进行了综述。     

前列腺癌组织学肿瘤标志物研究进展

前列腺癌(PCa)患者的生存率有赖于早期诊断和治疗,生物学标志往往能在其他手段检出癌症之前揭示其存在。利用前列腺组织中的肿瘤标志物,如前列腺特异膜抗原(PSMA)、高分子量细胞蛋白(CK34βE12)、P63、α-甲酰基辅A-消旋酶(AMACR)、Pca-24、端粒酶和端粒酶逆转录酶(hTERT)、前列腺特异基因DD3、钙磷脂结合蛋白Ⅲ(Annexin A3)以及谷胱甘肽S转移酶P1(GSTP1)甲基化等,对PCa进行早期诊断简便易行,但是单一指标的敏感性和特异性有限,多种标志物的联合检测将显著提高PCa诊断的准确率,是未来进行肿瘤筛选和早期诊断研究的重要发展趋势。     

Früherkennung von Prostatakarzinomen

The euphoria over PSA as an optimal marker for prostate cancer is gone. Measuring PSA levels has several deficiencies in detecting prostate cancer. First results of the randomized studies ERSPC and PLCO were not able to conclusively prove the value of PSA-based screening. Many attempts have been made to optimize early detection of prostate cancer like using modern imaging techniques or new biomarkers. This review deals with PSA isoforms und emerging biomarkers for the diagnosis of prostate cancer. Despite the inadequacies of PSA it is still the most important marker for the early detection of prostate cancer. Modern biomarkers with the ability to reliably predict aggressive prostate cancer are still missing.     

Beyond PSA: Utility of novel tumor markers in the setting of elevated PSA

The introduction of prostate-specific antigen (PSA) for prostate cancer screening and detection has been used for over 20 years and has dramatically changed the face of prostate cancer. Although it is a highly sensitive serum test, its routine use has been the subject of continued controversy owing to its limited specificity. Due to this lack of specificity, many have proposed modifications of PSA in an attempt to bolster the performance of this analyte. The human genome project and high throughput gene expression profiling has recently yielded several promising molecular biomarkers for prostate cancer detection beyond PSA or PSA modifications. This review will first highlight several characteristics of an ideal biomarker, then focus on select emerging biomarkers for the detection of prostate cancer.     

Prostate-specific antigen: An evolving role in diagnosis, monitoring, and treatment evaluation in prostate cancer

Prostate specific antigen (PSA) was introduced as a prostate cancer screening tool more than 20 years ago. However, there is continuing debate regarding its utility in screening for prostate cancer. Mass screening is costly, may result in the diagnosis and treatment of prostate cancers that never become clinically significant, and the evidence of a subsequent reduction in mortality is inconclusive. In addition to its role in screening, PSA is also used to monitor the progression of the disease, both localized and metastatic. Although the evidence is contradictory, PSA is still an important tool for monitoring patient progression following treatment of definitive localized prostate cancer. However, its use in monitoring castrate-resistant prostate cancer (CRPC) is more controversial, particularly in the context of novel targeted treatments, which may have little impact on PSA levels. These issues highlight the urgent need to identify prostate cancer biomarkers that will improve early disease detection, increase accuracy of diagnosis, determine the aggressiveness of disease, and monitor treatment efficacy, particularly in late-stage disease. This review discusses the key issues associated with the use of PSA as an early screening tool for prostate cancer, as a prognostic marker to measure disease progression in both early- and late-stage prostate cancer, and as a surrogate endpoint in clinical trials with new agents.     

Prostatic fluid electrolyte composition for the screening of prostate cancer: a potential solution to a major problem

Early detection is the key to effective treatment of prostate cancer, and to the prevention of deaths due to progression to untreatable advanced stage cancer. Because of mitigating factors, especially benign prostatic hyperplasia (BPH), that result in a low accuracy (about 60%) of prostate-specific antigen (PSA) testing, there is an urgent need for a more reliable biomarker for the identification of early stage through advanced stage prostate cancer and 'at-risk' individuals. To address this issue we propose that changes in prostatic fluid composition could provide accurate and reliable biomarkers for the screening of prostate cancer. Most notable is the consistent and significant decrease in citrate and zinc that is associated with the development and progression of prostate cancer. In this review we provide the clinical and physiological basis and the evidence in support of the utility of prostatic fluid analysis as an effective approach for screening/detection of prostate cancer, especially early stage and 'at-risk' subjects. The problem of BPH interference that plagues PSA testing is eliminated in the potential prostatic fluid biomarkers. The potential development of rapid, simple, direct, accurate clinical tests provides additional advantageous conditions. Further exploration and development of citrate, zinc and other electrolytes as prostatic fluid biomarkers are urgently needed to address this critical prostate cancer issue.     

Novel approaches to improve prostate cancer diagnosis and management in early-stage disease

The reported incidence of prostate cancer has risen since the implementation of screening. It is felt that the introduction of widespread prostate-specific antigen testing is responsible for most patients with prostate cancer now being diagnosed with asymptomatic, clinically localised disease. Diagnosis at this stage is associated with significantly improved treatment outcomes and longer life expectancy. Although there is evidence that screening has reduced prostate cancer mortality, there is a risk of over-diagnosis and over-treatment of early state prostate cancers, including clinically insignificant and indolent cancers. Active surveillance and focal therapy have been advocated as potential management options for some patients. However, these approaches face several challenges. Biopsy sampling errors together with less than optimal imaging of tumours can lead to difficulties in selecting suitable low-risk patients for these options. To overcome these challenges, novel approaches to the staging and monitoring of patients with early prostate cancer are being developed. These include new imaging techniques, such as multi-parametric magnetic resonance imaging, and the development of new biomarkers and biopsy-based methods. These techniques aim to assess the potential of a specific tumour to be aggressive, and to improve patient outcomes. The aim of the present paper is to summarise presentations and debates at the third annual Interactive Genitourinary Cancer Conference concerning the use of population-based screening methods and the roles of active surveillance and focal therapy as prostate cancer treatments. The application of novel imaging biopsy-based methods and biomarkers in early-stage prostate cancer will also be explored.     

Risk-Based Prostate Cancer Screening: Who and How?

The purpose of this review is to identify clinical risk factors for prostate cancer and to assess the utility and limitations of our current tools for prostate cancer screening. Prostate-specific antigen is the single most important factor for identifying men at increased risk of prostate cancer but is best assessed in the context of other clinical factors; increasing age, race, and family history are well-established risk factors for the diagnosis of prostate cancer. In addition to clinical risk calculators, novel tools such as multiparametric imaging, serum or urinary biomarkers, and genetic profiling show promise in improving prostate cancer diagnosis and characterization. Optimal use of existing and future tools will help alleviate the problems of overdiagnosis and overtreatment of low-risk prostate cancer without reversing the substantial mortality declines that have been achieved in the screening era.     

前列腺癌诊断标志物研究现状

随着前列腺特异性抗原（PSA）的广泛应用,前列腺癌（PCa）患者及前列腺穿刺活检数量明显增加,但PSA特异性及对前列腺癌的诊断价值仍然存在争议。目前已出现更多诊断PCa的DNA、RNA和抗原标志物,本文将对与PCa诊断相关的肿瘤标志物研究现状作一简要概述。