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DOI: 10.1055/s-0029-1224535
© Georg Thieme Verlag Stuttgart ˙ New York
Neue Biomarker und Anwendung multivariater Modelle zur Detektion des Prostatakarzinoms
New Biomarkers and Application of Multivariate Models for Detection of Prostate CancerPublication History
Publication Date:
24 July 2009 (online)
![](https://www.thieme-connect.de/media/uro/200904/lookinside/thumbnails/10.1055-s-0029-1224535-1.jpg)
Zusammenfassung
Molekulare Formen des prostataspezifischen Antigens (PSA) und des freien PSA (fPSA) wie das prozentuale freie PSA (%fPSA), proPSA, intaktes PSA oder das BPHA und andere neue Marker können die diagnostische Spezifität des PSA verbessern. Bei vielen der neuen Marker wie EPCA2 im Serum oder Annexin A3 (ANXA3) im Urin konnten die ersten guten Ergebnisse bisher noch nicht bestätigt werden bzw. es zeigte sich nur eine marginale Verbesserung der Spezifität. Andere Urinmarker wie das PCA3 oder das TMPRSS2-ERG Genfusionsprodukt haben das Potenzial, bevorzugt aggressive Tumoren zu entdecken und die Rate unnötiger Prostatabiopsien zu senken. Die Kombination dieser neuen Urinmarker mit etablierten Serummarkern könnte zukünftig eine weitere Spezifitätsverbesserung des Gesamt-PSA (tPSA) bewirken. Durch den Einsatz multivariater Modelle wie z. B. artifizielle neuronale Netzwerke (ANN) oder auf logistischer Regression (LR) basierte Nomogramme, die eine kombinierte und gleichzeitige Bewertung verschiedener Marker ermöglichen, ist in dieser Hinsicht ein weiterer Fortschritt zu erzielen. Diesen deutlichen Vorteil der multivariaten Bewertung gegenüber der Anwendung einzelner Parameter hat bereits die Nutzung des %fPSA innerhalb von ANN- und LR-Modellen gezeigt. In dieser Übersichtsarbeit werden neue Marker zur Detektion des Prostatakarzinoms (PCa) und deren Einsatz innerhalb multivariater Modelle eingeschätzt.
Abstract
The specificity of PSA has been enhanced by using molecular forms of PSA and free PSA (fPSA) such as percent free PSA (%fPSA), proPSA, intact PSA or BPHA and / or new serum markers. Most of these promising new serum markers like EPCA2 or ANXA3 still lack confirmation of the outstanding initial results or show only marginally enhanced specificity at high sensitivity levels. PCA3, TMPRSS2-ERG, and other analytes in urine collected after digital rectal examination with application of mild digital pressure have the potential to preferentially detect aggressive PCa and to decrease the number of unnecessary repeat biopsies. The combination of these new urinary markers with new and established serum markers seems to be most promising to further increase specificity of tPSA. Multivariate models, e. g., artificial neural networks (ANN) or logistic regression (LR) based nomograms have recently been performed by incorporating these new markers in several studies. There is generally an advantage to include the new markers and clinical data as additional parameters to PSA and %fPSA within ANN and LR models. Results of these studies and also unexpected pitfalls are discussed in this review.
Schlüsselwörter
Prostatakarzinom - Diagnostik - PSA - Biomarker - multivariate Modelle
Key words
prostate cancer - diagnosis - PSA - biomarkers - multivariate models
- Ein Editorial Comment zur Übersicht finden Sie Online in
- Editorial Comment on the Review .
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PD Dr. C. Stephan
Klinik und Poliklinik für Urologie · Charité – Universitätsmedizin Berlin · CCM
Charitéplatz 1
10117 Berlin
Germany
Phone: +49 / 30 / 4 50 61 51 59
Fax: +49 / 30 / 4 50 51 59 04
Email: carsten.stephan@charite.de
- Thieme-connect