A Duplex Quantitative Polymerase Chain Reaction Assay Based on Quantification of α-Methylacyl-CoA Racemase Transcripts and Prostate Cancer Antigen 3 in Urine Sediments Improved Diagnostic Accuracy for Prostate Cancer

Abstract

Purpose Most men with elevated serum prostate-specific antigen (PSA) levels and negative biopsies require repeat biopsy because of the lack of a sensitive and specific prostate cancer (CaP) detection test. This study evaluated the diagnostic potential of a duplex assay for CaP by quantifying transcript levels of α-methylacyl-CoA racemase (AMACR) and prostate-cancer antigen 3 (PCA3) in urine sediments following prostatic message. Materials and Methods Urine sediments from 92 patients, 43 with 49 without CaP were collected after digital rectal examination. Transcript levels of AMACR, PCA3, and PSA in total RNA isolated from these samples were determined by absolute qRT-PCR. AMACR and PCA3 scores were obtained by normalizing the transcript level to that of PSA for each sample and multiplying by 100. Results AMACR (p=0.006) and PCA3 (p=0.014) scores, but not serum PSA (p=0.306), discriminated specimens from patients with and without CaP, Receiver-operating-characteristic analysis established the diagnostic cutoff scores for the AMACR and PCA3 tests at 10.7 and 19.9, respectively. As determined from these cutoff scores, the AMACR test has 70% (95% CI, 56-83%) sensitivity and 71% (95% CI, 59-84%) specificity, whereas the PCA3 test has 72% (95% CI, 59-85%) sensitivity and 59% (95% CI, 45-73%) specificity for CaP detection. The combined use of AMACR and PCA3 scores in a dual-marker test increased sensitivity to 81% (95% CI, 70-93%) and specificity to 84% (95% CI, 73-94%). Conclusions Urinary AMACR and PCA3 tests were both superior to serum PSA test for detecting CaP. Their combined use in a dual-marker test further improved sensitivity and accuracy and could be used as a surveillance test after repeat negative prostate biopsies.

Nested polymerase chain reaction technique for the detection of Gpc3 and Afp mRNA in liver cancer micrometastases

“…AFP is highly expressed in the fetal yolk sac, but is hardly expressed in healthy adults. However, AFP is expressed during liver cancer and can be used as a biomarker for it (Mearini et al, 2009;Ouyang et al, 2009;Filella and Giménez, 2013). Our study showed that the rate of occurrence of Afp mRNA in the peripheral blood of rats with liver cancer was 48.1% (39/81), and increased significantly with cancer progression, indicating an association between Afp mRNA levels and the number of hepatoma cells.…”

Recommendations from the EGAPP Working Group: does PCA3 testing for the diagnosis and management of prostate cancer improve patient health outcomes?

“…However, 12 additional studies included matched results of PCA3 and the comparators but enrolled men with both initial and repeat biopsies or they did not report biopsy history. 10,11,[35][36][37][38][39][40][41][42][43][44] Most often, the results from these studies were not stratified by biopsy history.…”

“…Fifteen studies [9][10][11]30,32,[34][35][36][37][38][39][40][41][42][43]46 reported AUC estimates for tPSA and PCA3 in the same population. Overall, 13 [9][10][11]30,32,34,35,37,38,[40][41][42]46 of the15 studies found that the AUC of PCA3 was higher than that of tPSA.…”

Evaluación del test PCA3 para el diagnóstico de cáncer de próstata: revisión sistemática y metanálisis

“…Los estudios incluidos finalmente, tras la lectura a texto completo, fueron 14 estudios de pruebas diagnó sticas 3,7,8,[15][16][17][18][19][20][21][22][23][24][25] que cumplieron los criterios de inclusió n ( fig. 1) y un informe de una agencia de evaluació n de tecnología sanitaria elaborado por )National Horizon Scanning Centre* 26 que sintetizaba resultados varios estudios en los que en todos se obtenía buena especificidad y sensibilidad.…”

“…En todos los trabajos se describían los criterios de selecció n de pacientes y estos eran representativos de toda la població n. El gold standard utilizado (biopsia) fue adecuado en todos los casos y este siempre era comparado con la intervenció n. En 5 artículos la realizació n de las 2 pruebas no se realizó de manera simultá nea [15][16][17]20,24 y en uno el gold standard no se aplicó a todos los pacientes 20 . El cegamiento de los investigadores para la interpretació n de la prueba de referencia solo se registró 2 estudios 7,19 .…”