联合检测TPSA、FPSA、FPSA/TPSA对前列腺癌的诊断价值

目的探讨血清中总前列腺特异性抗原(TPSA)、游离前列腺特导性抗原(FPSA)及FPSA/TPSA比值在前列腺疾病诊断中的价值。方法采用全自动电化学发光分析技术,检测45例健康男性,40例前列腺增生(BPH)患者和32例前列腺癌(PCa)患者血清中的TPSA和FPSA含量,计算FPSA/TPSA比值,并进行统计学分析。结果 BPH组及PCa组的TPSA和FPSA值均显著高于正常对照组,而PCa组FPSA/TPSA比值显著低于正常对照组和BPH组。当TPSA值在4.1~60.0 ng/mL时,BPH和PCa出现交叉重叠现象,单靠TPSA一项指标难以提高PCa诊断率。BPH组的FPSA/TPSA很少0.11,PCa组的FPSA/TPSA很少0.20。由此,FPSA/TPSA比值的测定可用于BPH和PCa的鉴别诊断。结论联合检测血清中TPSA、FPSA的含量及FPSA/TPSA比值,可大大提高PCa的诊断率,对PCa早期诊断及鉴别诊断有重要意义。     

免疫组织化学技术在前列腺癌早期诊断中的应用现状

前列腺癌（prostate cancer,PCa）是欧美国家男性发病率第一和死亡率第二的恶性肿瘤^1[]。由于PCa自然病程较长,临床症状隐匿,许多患者被发现时已处于晚期,因此,PCa的早期诊断成为临床上关注的焦点。血清前列腺特异性抗原（prostatespecific antigen,PSA）对PCa的敏感性和特异性较低,特别是PSA水平介于4～10ng／ml之间时^[2]。目前,前列腺穿刺活检仍是诊断PCa的金标准,但穿刺活检标本有限,许多良性病变与PCa的组织学特征相似,给临床上PCa的诊断带来很大困难。     

AMACR联合CK34βE12与p63在前列腺癌早期诊断的应用现状

目的:总结免疫组织化学技术在前列腺癌(PCa)早期诊断中的应用。方法:应用Medline、EMCC及CNKI期刊全文数据库检索系统,以"α-甲基酰基辅酶A消旋酶、前列腺肿瘤、诊断"等为关键词,检索2000-01-2008-05相关文献。纳入标准:1)前列腺基底细胞标志。2)AM-ACR在前列腺组织中的表达。3)AMACR的临床应用。4)AMACR与34βE12、p63的联合应用。粗选有114篇AMACR与PCa诊断方面的文章,根据纳入标准,精选58篇文献,最后纳入分析24篇文献。结果:在前列腺针刺活检标本中,AMACR检测PCa的敏感性为80%~100%,特异性为70%~100%,具有较高的敏感性及特异性。CK34βE12、p63是前列腺基底细胞标志,在PCa中呈阴性表达。结论:AMACR联合CK34βE12、p63能够提高PCa的早期诊断率,在PCa的发生、发展、诊断和治疗方面具有重要的应用价值。     

游离前列腺特异性抗原与总前列腺特异性抗原比值在前列腺癌鉴别诊断中的应用

 目的 探讨游离前列腺特异性抗原（fPSA）与总前列腺特异性抗原（tPSA）比值在前列腺癌（PCa）鉴别诊断中的意义。方法 采用电化学免疫发光技术对86例前列腺良性增生（BPH）45例PCa患者和60例健康男性体检者（正常对照组）血清fPSA和tPSA同时进行测定，并计算出fPSA／tPSA，进行统计分析。结果 BPH、PCa组tPSA水平明显高于正常对照组（P＜0.05）。PCa组和BPH组的血清tPSA差异亦有统计学意义，但当tPSA在4.0 ~ 10.0 μg／L范围时，PCa组血清fPSA／tPSA比值却明显低于BPH组（P＜0.01）。把fPSA／tPSA比值划分成8个区间，当fPSA／tPSA比值15 ％作为诊断灰区PCa诊断的临界值时，诊断的敏感性、特异性、阳性预测值、阴性预测值及正确诊断指数分别为72.8 %、67.5 %、62.5 %、82.2 %、50.2 %。结论 当血清tPSA处于诊断灰区时，联合检测fPSA／tPSA比值可明显提高tPSA对PCa早期诊断的特异性。     

AMACR联合OK34βE12与p63在前列腺癌早期诊断的应用现状

目的:总结免疫组织化学技术在前列腺癌(PCa)早期诊断中的应用.方法:应用Medline,EMCC及CNKI期刊全文数据库检索系统,以"a-甲基酰基辅酶A消旋酶、前列腺肿瘤、诊断"等为关键词,检索2000-01-2008-05相关文献.纳入标准:1)前列腺基底细胞标志.2)AM-ACR在前列腺组织中的表达.3)AMACR的临床应用.4)AMACR与34βE12、p63的联合应用.粗选有114篇AMACR与PCa诊断方面的文章,根据纳入标准,精选58篇文献,最后纳入分析24篇文献.结果:在前列腺针刺活检标本中.AMACR检测PCa的敏感性为80%～100%,特异性为70%～100%,具有较高的敏感性及特异性.CK34βE12、p63是前列腺基底细胞标志,在PCa中呈阴性表达.结论:AMACR联合CK34βE12、p63能够提高PCa的早期诊断率,在PCa的发生、发展、诊断和治疗方面具有重要的应用价值.     

F-PSA/T-PSA联合MRI在前列腺癌诊断中的应用价值

目的 探讨MRI联合血清游离前列腺特异性抗原(F-PSA)以及总PSA(T-PSA)比值对于前列腺癌(PCa)的诊断价值.方法 对病理确诊为前列腺良恶性疾病的103例患者,比较单独应用MRI以及MRI联合F-PSA/T-PSA诊断PCa的敏感性、特异性以及准确性.结果 103例患者中有39例患者被诊断为PCa,其中MRI诊断的敏感性、特异性以及准确性分别为89.74%、81.25%、85.87%,将MRI以及F-PSA/T-PSA比值联合诊断,发现选取0.15为截点时对PCa具有最大的诊断价值,其敏感性、特异性以及准确性分别为87.18%、89.06%、89.91%.结论 MRI联合F-PSA/T-PSA可以明显提高前列腺癌的诊断率,有助于早期发现前列腺癌并进行治疗.     

膀胱癌早期诊断方法的研究进展

摘 要：膀胱癌的早期诊断是影响患者预后的重要因素。目前膀胱癌的早期诊断方法主要依赖尿脱落细胞学检测、膀胱镜检查、影像学检查、肿瘤标志物检测和活检等。全文对传统的早期诊断方法作一概述，并对新型光学成像技术、肿瘤标志物、基因检测位点、改良膀胱镜以及多种方法联合检测等方法的优劣势进行综述。     

基于TCGA数据库分析叉头盒蛋白FoxO1在 前列腺癌中的表达及其作用

目的：分析叉头盒蛋白FoxO1在前列腺癌（PCa）组织中的表达,探讨其对PCa早期诊断和预后的作用。方法：利用癌症基因图谱（TCGA）数据库下载正常前列腺组织和PCa组织中FoxO1 mRNA表达谱及临床信息资料,通过GEPIA数据库分析FoxO1mRNA表达与PCa临床病理学指标的关系及对预后的影响。采用Cox回归分析探讨PCa患者预后的影响因素。应用人类蛋白质表达图谱中的免疫组化结果分析FoxO1蛋白在正常前列腺组织和PCa组织中的表达情况。结果：与正常前列腺组织相比,FoxO1mRNA在PCa中表达降低（P<0.05）,并且表达水平与肿瘤浸润深度、远处转移、分化程度存在相关关系（P均<0.05）。进一步研究发现FoxO1 mRNA高表达患者的无病生存率明显高于低表达患者（P<0.05）。Cox多因素分析结果表明,肿瘤浸润深度、分化程度和FoxO1表达水平是PCa患者预后的独立影响因素（P<0.05）。免疫组化结果显示,与正常前列腺组织相比,PCa中FoxO1的蛋白表达量亦显著降低（P<0.05）。结论：FoxO1基因在PCa组织中表达降低,其可能是一个抑癌基因,该基因的表达水平检测对前列腺癌患者的诊断和预后判断具有参考价值。     

前列腺肿瘤标志物的研究进展及临床意义

前列腺癌(PCa)是男性泌尿生殖系统常见的恶性肿瘤之一.随着近些年的研究发现和应用,除了临床现阶段常用的前列腺特异性抗原(PSA)及fPSA肿瘤标志物的使用外,诸如一些α-甲酰基辅酶A消旋酶(AM-ACR,P504S)、前列腺特异性膜抗原(PSMA)、PCA3(DD3)基因等众多新型前列腺肿瘤标志物也应运而生,并且也逐渐在科研甚至临床中使用.众所周知,目前PCa的诊断方法常见的有直肠指检,PSA数值的判定,经直肠前列腺超声检查及前列腺穿刺活检.其中肿瘤标志物的选择对PCa的初筛及后续的诊疗计划起到承前启后的作用.因此,对于前列腺恶性肿瘤标志物的研究便显得尤为重要.本文着重对近年来前列腺肿瘤标志物的研究进展进行综述并阐述其临床意义.     

直肠超声引导经会阴途径穿刺活检诊断前列腺癌

目的:通过总结经直肠超声(TRUS)引导下经会阴途径前列腺癌(PCa)穿刺活检患者的临床表现、相关检查及病理特征,提高对PCa穿刺活检的病理诊断水平.方法:选择2014年7月至2016年12月期间于我院行TRUS引导下经会阴途径PCa穿刺活检患者101例,对这些患者的临床表现、血清PSA检查、影像学检查及病理检查进行总结.结果:PCa患者年龄多大于60岁,多伴有泌尿系统症状与直肠指检异常、血清PSA常超出上限;影像学表现为病变区域图像改变与血流信号异常;镜检特征主要表现在细胞异型、结构异型和浸润性生长,镜下特征性结构与免疫组化检查有助于PCa的诊断.结论:前列腺穿刺活检病理检查是诊断PCa的金标准,在熟练掌握其病理特征与免疫组化表达的同时,注意结合PCa临床表现与临床相关检查的特点,对提高病理诊断准确性具有重要的临床意义.     

DNA异常甲基化在前列腺癌发生发展及诊疗中的研究进展

前列腺癌是全球男性常发的恶性肿瘤之一。近年来研究发现前列腺癌的发生发展很大程度上是由表观遗传修饰所驱动的,其中最重要的当属DNA异常甲基化。DNA启动子的异常甲基化会造成基因的异常表达,从而调控着前列腺癌的发生发展过程。此外,目前前列腺癌的诊断仍然依靠侵入性的前列腺穿刺活检,而基于DNA异常甲基化的无创性液体活检有望成为未来前列腺癌分子诊断的发展趋势,同时也为前列腺癌提供了新的治疗靶标。本文就DNA甲基化在前列腺癌发生发展、早期诊断、预后评估以及治疗中的研究进展进行综述。     

Function of PCA3 in prostate tissue and clinical research progress on developing a PCA3 score

Prostate cancer gene 3 （PCA3, also known as DD3） is a new biomarker that could improve the accuracy of prostate cancer diagnosis. It is a great biomarker with fairly high specificity and sensitivity. The incidence of prostate cancer is rising steadily in most countries. The commonly used prostate-specific antigen （PSA） test once gave people hope for early diagnosis of prostate cancer. However, the low specificity of the PSA test has resulted in a large number of unnecessary biopsies and overtreatment. During the past decade, many new prostate cancer biomarkers have been found. Among these, PCA3 is the most promising. Due to its great performance in distinguishing prostate cancer from other prostate conditions, PCA3 could likely be applied for early diagnosis of prostate cancer, patient follow-up, prognosis prediction, and targeted therapy. After years of research, we have obtained some knowledge about the sequence of PCA3 gene. We have also determined the relationship between PCA3 and the proliferation of prostate cancer cells and learned some information about how PCA3 affects tumor-related genes and proteins. A PCA3 score has been created, and it has been used in a variety of studies. Some researchers have even applied PCA3 to targeted therapy and obtained a good effect in vitro. This review describes the current state of research, and explores the future prospects for PCA3.     

Detection of DNA hypermethylation as a potential biomarker for prostate cancer

Prostate cancer is one of the most common malignant diseases in men above the age of 50. A genetic predisposition and/or acquired genetic and epigenetic changes together with lifestyle contribute to the development of the disease. The most studied epigenetic modification in prostate cancer is the methylation of the cytosine located within the dinucleotide CpG of promoter regions of different genes by methylation specific PCR. The evidence of gene silencing by DNA methylation in genes like GSTP1, APC or RASF1 is a common and relatively specific event in prostate cancer. DNA methylation testing can be performed on tissue samples or urine, ejaculate or serum. Translational research is searching for new biomarkers for early detection and prognosis of prostate cancer, but because of large methodological differences in applied techniques and patient cohorts, the investigations have yielded promising, but also some controversial results. More prospective randomized trials and standardized methods are needed to assess the true value of methylation for the diagnosis and prognosis of prostate cancer.     

纳米生物传感器在前列腺癌早期检测中的应用

纳米生物传感器是纳米技术与生物传感器的融合,其研究涉及纳米技术、生物技术、微电子技术和分析技术等多个重要领域。近年来,随着各种纳米材料的不断涌现和纳米技术的蓬勃发展,纳米生物传感器在疾病诊断领域展现出日益广泛的应用性。前列腺癌是当前威胁全世界男性健康的主要恶性肿瘤之一,对低浓度的前列腺癌标志物进行高效检测有利于前列腺癌的早期诊断、治疗监测及复发预测,具有重要的临床意义。本文针对生物传感器在前列腺癌标志物检测中的应用,介绍近年来纳米生物传感技术在前列癌早期诊断中的研究进展与应用前景。      

84例可疑前列腺癌超声引导下多点穿刺活检体会

目的：探讨经直肠超声引导下前列腺多点穿刺活检技术在诊断早期前列腺癌中的价值。方法：对84例可疑前列腺癌患者行经直肠超声引导下前列腺多点穿刺活检。结果：活检经病理证实其中前列腺癌31例,前列腺增生症38例,前列腺内皮瘤形成7例,不典型增生2例,炎症5例,结核1例。结论：经直肠超声引导下前列腺多点穿刺活检操作简便、成功率高、并发症少;有助于诊断及鉴别诊断前列腺疾病,可以明显提高早期前列腺癌的诊断率,具有重要的临床应用价值,值得推广。     

84例可疑前列腺癌超声引导下多点穿刺活检体会

目的:探讨经直肠超声引导下前列腺多点穿刺活检技术在诊断早期前列腺癌中的价值。方法:对84例可疑前列腺癌患者行经直肠超声引导下前列腺多点穿刺活检。结果:活检经病理证实其中前列腺癌31例,前列腺增生症38例,前列腺内皮瘤形成7例,不典型增生2例,炎症5例,结核1例。结论:经直肠超声引导下前列腺多点穿刺活检操作简便、成功率高、并发症少;有助于诊断及鉴别诊断前列腺疾病,可以明显提高早期前列腺癌的诊断率,具有重要的临床应用价值,值得推广。     

CT screening for lung cancer: update 2007

Screening is the pursuit of the early diagnosis of cancer before symptoms occur. The purpose of early diagnosis is to provide early treatment, which potentially prevents death from the cancer. The usefulness of screening depends on how early the cancer can be diagnosed and how many deaths can be prevented by early treatment as compared with later symptom-prompted diagnosis and treatment. The goal of the Early Lung Cancer Action Project investigators was to develop an efficient methodology that would provide an ever-accumulating, continually updated body of evidence for evaluation of emerging new technologies for screening for cancer. This methodology recognizes that screening is a sequential process that starts with the pursuit of the early diagnosis of cancer followed by early treatment. It also recognizes that diagnostic research is fundamentally different from treatment research. To fully understand the current discussions on the evidence for lung cancer screening, key definitions are provided, including the differentiation between the first, baseline round of screening and all subsequent rounds of repeat screening and baseline and repeat cancers and their distribution by cell type. These definitions are critical in analyzing the results of various screening reports as they are not used by all. To provide optimal screening, a regimen for the diagnostic workup must be specified starting with the definition of the initial test, its positive result, and the workup for a positive result leading to a diagnosis of cancer. Assessment of diagnostic performance does not require a control group, but does require confirmation of the diagnosis. For assessment of the effectiveness of early treatment, a comparison group is needed. The comparison group may be formed by randomly assigning people with screen-diagnosed lung cancer to immediate or delayed treatment, as has been done for prostate cancer. This provides a direct assessment of any potential overdiagnosis of the cancer resulting from screening. Alternatively, a quasiexperimental control group can be used consisting of participants diagnosed with the cancer who have refused or delayed their treatment even though they are candidates for it.     

The role of new modalities in the early detection and diagnosis of prostate cancer

New as well as standard techniques for the detection and diagnosis of early prostate cancer have been described. These include the use of digital rectal examination, prostate-specific antigen, transrectal ultrasound, prostatic acid phosphatase, the Biopty gun, and cell ploidy, as well as the diagnosis of premalignant lesions of the prostate, such as prostatic dysplasia or, more appropriately, prostatic intraepithelial neoplasia. All of these innovations may enhance our ability to diagnose and follow patients with early prostate cancer. Full documentation and evaluation of long-term (15 to 20 years) follow-up, however, are needed to determine whether these new techniques will make a difference in the ultimate morbidity and mortality of prostate cancer in the United States. In the meantime, however, the use of these new diagnostic tools should not be avoided. We must advance with technology, and as the technologies grow and develop we should increase our understanding about the utility of each of these new tests and combine them with the older standard tests that have served us well for many years.     

前列腺癌正电子显像剂的临床研究及应用进展

PET/CT及PET/MR近年来已被应用于前列腺癌的临床检测。通过应用不同的显像剂，PET/CT及PET/MR可以评估前列腺癌的糖代谢、脂质代谢、受体变化等生物学改变，在前列腺癌的诊断、指导治疗及预后评估等方面相对于常规检测手段有独特的优势和良好的效果。近年来，许多新的放射性标记物不断被引入临床，给前列腺癌的诊断及治疗带来更广阔的应用前景。本文主要对前列腺癌正电子显像剂的临床研究及应用进展进行综述。     

外周血miRNA应用于肿瘤早期诊断的研究进展

微小RNA（microRNA,miRNA）是由20~25 个核苷酸组成的非编码RNA分子,其在肿瘤的发生发展过程中起着重要的调节作用,包括癌细胞的增殖、分化、凋亡等,直接影响肿瘤的进展。外周血miRNA相对稳定,比组织miRNA容易获取和检测,是肿瘤早期发现、早期诊断的新一代生物标志物,也是精准医学研究应用的主要发展方向之一。外周血miRNA常用的检测方法主要有逆转录实时荧光定量PCR,电化学检测、NanoString 数字化基因检测、基因芯片和高通量测序等。外周血多种miRNA是非小细胞肺癌、食管鳞癌、胰腺癌、头颈鳞状细胞癌、卵巢癌、结直肠癌、乳腺癌、前列腺癌和血液肿瘤的早期诊断标志物,多个外周血miRNA联合检测以及肿瘤特异性miRNA与血清学、影像学等辅助手段联合检测,均可提高肿瘤早期诊断的灵敏度和特异性。