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The level of evidence for the use of biomarkers in the early detection of prostate cancer

机译：在前列腺癌的早期检测中使用生物标志物的证据水平

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To systematically review the evidence for the use of PSA and other biomarkers in the early detection of prostate cancer, we searched PubMed for clinical trials and studies assessing PSA and other biomarkers in the early detection of prostate cancer, published between 2000 and May 2013 that included >200 subjects. The level of evidence (LOE) for clinical utility was evaluated using the tumor marker utility grading system. A total of 84 publications, corresponding to 70 trials and studies were selected for inclusion in this review. We attributed a level of evidence (LoE) of IA to PSA for early PCa detection, but we do not recommend its use in mass screening. Emerging biomarkers were assessed in prospective case-control and cohort studies: PCA3 (n=3); kallikreins (n=3); [-2]proPSA (n=5); fusion oncogenes (n=2). These studies used biopsy results for prostate cancer to determine specificity and sensitivity, but they did not assess the effect on PCa mortality. The LoE attributed was III-C. PSA can be used for early prostate cancer detection but mass screening is not recommended. Studies on other biomarkers suggest that they could be used, individually or in combination, to improve the selection of patients with elevated PSA levels for biopsy, but RCTs assessing their impact on prostate cancer management and mortality are needed. A better use of available tests is possible for men at risk in order to maximize the risk-benefit ratio.
机译：为了系统地审查在前列腺癌的早期检测中使用PSA和其他生物标志物的证据，我们在PubMed中搜索了临床试验和评估PSA和其他生物标志物在前列腺癌的早期发现中的研究，该研究于2000年至2013年5月之间发表，其中包括> 200个科目。使用肿瘤标志物效用分级系统评估了临床效用的证据水平（LOE）。总共选择了84篇出版物，对应70项试验和研究，以纳入本评价。我们将IA的证据水平（LoE）归因于PSA以便早期检测PCa，但我们不建议将其用于大规模筛查。在前瞻性病例对照和队列研究中评估了新兴的生物标志物：PCA3（n = 3）;激肽释放酶（n = 3）; [-2] proPSA（n = 5）;融合癌基因（n = 2）。这些研究使用前列腺癌的活检结果来确定特异性和敏感性，但他们并未评估对PCa死亡率的影响。归因于LoE是III-C。 PSA可用于早期前列腺癌的检测，但不建议进行大规模筛查。对其他生物标志物的研究表明，它们可以单独或组合使用，以改善对PSA水平升高的患者进行活检的选择，但是需要进行RCT评估其对前列腺癌治疗和死亡率的影响。有风险的男人可以更好地利用可用的测试，以最大程度地提高风险收益率。

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