| Objective:1. To study PC A3diagnostic sensitivity and specificity in prostate cancer by the PCA3urine test. To demonstrate the superiority of the PCA3urine test compare to PSA, in terms of predictive value, specificity and sensitivity.2. To determine the relationship between blood PCA3mRNA and distant metastasis of prostate cancer.3. To discuss the significance of blood PC A3mRNA in the treatment and monitoring of prostate cancer.Methods:We collected the peripheral blood and urine after digital rectal examination of119cases of PCa and207benign prostatic hyperplasia (BPH) patients. By using cell separation, RNA extraction, RT-PCR, agarose gel electrophoresis and radiation imaging technology, we analyzed the expression of PCA3in blood and urine of patients and found out the application value of PCA3mRNA compared to PSA.Results:1. There were231cases with serum PSA>4ng/ml in326study cases, including113PCa cases and118BPH cases. There were104cases with urinary PCA3mRNA positive, of which100PCa cases and4BPH cases. The sensitivity, specificity, accuracy, PPV, NPV,+LR,-LR of Serum PSA test was94.96%,43.00%,61.96%,48.92%,93.68%,1.67,0.12respectively. While the sensitivity, specificity, accuracy, PPV, NPV,+LR,-LR of PCA3mRNA urine test was84.03%,98.07%,92.94%,96.15%,91.44%,43.49,0.16respectively. The prostate cancer detection rate by PCA3mRNA in urine (96.15%,100/104) was much higher than that by serum PSA (48.92%,113/231), P<0.01. In addition, pathological results showed that8PCa cases and69BPH cases in77cases with PSA in the gray area4-10ng/ml, the PCa detection rate was10.39%. There were7cases with urinary PCA3mRNA positive, including6PCa cases and1BPH cases, the PCa detection rate was85.71%. The sensitivity and specificity of urinary PCA3mRNA in PCa diagnosis was75.00%and98.55%respectively.2. In119cases of PCa pretherapy patients, the blood PCA3mRNA positive rates of PCa with bone metastasis (78.26%,36/46) is much lower than that without bone metastasis (16.44%,12/73), P＜0.01. There were86cases with serum PSA>20ng/ml, including46PCa cases with bone metastasis and40PCa cases without bone metastasis, showed the bone metastasis detection rate was53.49%. There were48cases with urinary PC A3mRNA positive, including36PCa with bone metastasis cases,12PCa without bone metastasis cases, showed the bone metastasis detection rate was75.00%.3. After treatment, the blood PCA3mRNA-positive rate (8.04%,9/112) was decreased significantly than that of before the treatment (42.86%,48/112),(P＜0.01).Conclusion:1. PCA3mRNA urine test has the superiority over PSA, in terms of predictive value and specificity, albeit with a slightly lower sensitivity. The result is particularly encouraging for the specific population of patients who have a first negative biopsy; it could avoid unnecessary repeated biopsies. When PSA in the gray area4-10ng/ml, the biopsy results positive rate is lower (10.39%). The diagnostic specificity of urinary PCA3mRNA up to98.55%.PCA3mRNA urine test may be able to help determine the need for biopsy.2. PCA3mRNA-positive in blood may indicate the possibility of metastasis.3. PC A3mRNA detection in blood can be used as an auxiliary marker to monitor prognosis of PCa patients. |
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