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New Markers for Prostate Cancer
(p=0.03) and spinal cord injury patients (p=0.001). These results negative expression in bladder cancer samples. However, there was no
translated into a sensitivity of 92% and a specificity of 94%. correlation between the staining intensity and Gleason grade or
pathologic (pT) stage.
22
It was concluded that immunodetection of EPCA
EPCA-2 is another antigen with three epitopes: EPCA-2.4, -2.19 and in prostate is an early finding and can be used as an adjunct to current
-2.22. Leman et al. established the cut-off level with ELISA in a test group diagnostic methods.
and further determined the concentration of EPCA-2.22 in the sera of a
Recently, Hansel and co-workers showed that immunohistochemical
detection of EPCA in biopsy specimens may identify patients with
It was concluded that immunodetection
prostate cancer who had initial negative biopsies (59%).
23
However,
there was a potentially high (41%) false-negativity rate in patients with
of early prostate cancer antigen in
documented prostate cancer on concurrent biopsies, which makes the
prostate is an early finding and can be efficacy of this test questionable as a diagnostic tool.
used as an adjunct to current
Other markers include: alpha-methylacyl coenzyme A racemase
diagnostic methods. (AMACR), which is an isomerase that is overexpressed in virtually all
prostate cancers;
24
prostate cancer stem cell antigen (PSCA), a prostate-
specific glycoprotein that is expressed on the cell surface;
25–27
and
study population.
21
Analysis of data from 330 individuals showed a highly TMPRSS2-ERG fusion transcripts,
28–30
which are some of the other useful
specific assay discriminating prostate cancer patients from others. Using
a cut-off of 30ng/ml, the EPCA-2.22 assay had a 92% specificity (95% CI
85–96%) and 94% sensitivity (95% CI 93–99%). In comparison, the Recently, Hansel and co-workers
specificity of total PSA at a cut-off level of 2.5ng/ml was 65% with a
showed that immunohistochemical
sensitivity of 90%. ROC-curve analysis revealed an AUC of 0.98 for
EPCA-2.22 and 0.77 for PSA (p<0.001). EPCA-2.22 was also highly
detection of early prostate cancer
accurate in the identification of organ-confined disease (AUC 0.89) in
antigen in biopsy specimens may
comparison with PSA (AUC 0.63; p<0.0001). However, modification of
the assay protocol was required and, although it resulted in a significantly
identify patients with prostate cancer
lower background, this optimised assay still remains to be validated.
who had initial negative biopsies (59%).
Tissue expression of the EPCA protein was also a source of interest, and
94% of tumour samples from prostate cancer patients were positive for diagnostic tests in prostate cancer. However, their role is undetermined
expression by immunohistochemistry. This is in contrast to completely and awaits further clarification. ■
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