区域效应－一个前列腺癌早期诊断的新思路

目前临床上有许多怀疑前列腺癌但穿刺阴性的病例,为了避免漏诊,多数患者必须接受重复穿刺。尽管部分患者经重复穿刺确诊为前列腺癌,而更多患者经过长期随访以及反复穿刺最终确诊为良性病变。近期研究证实,癌灶附近的组织学表现正常的组织中也可发生与癌灶相似的分子改变。因此,我们认为在前列腺癌的发生过程中存在区域效应。在这一理论指导下,选择适当的可反映前列腺癌区域效应的标记物,在穿刺阴性的标本中检出与癌灶相似的分子改变,就可以帮助临床医生在常规病理诊断之前,提前预测前列腺癌的发生。如果能够找到这样的标记物,并在大规模的诊断试验中证实其可行性,那么就可以极大地改善前列腺癌诊断的现状。

Field effect-a New Idea for Early Diagnosis of Prostate Cancer

To diagnose prostate cancer, many repeat biopsies are needed in patients with prior negative biopsies to prevent missed diagnosis. Though prostate cancer might be detected by repeat biopsies in some patients, many other patients will never be diagnosed with this disease confirmed by long term follow-up and lots of unnecessary biopsies. Recent findings supported histological normal appearing tissue which adjacent to tumor focus, would develop similar molecular changes like cancer. Therefore, we believe that there is a field effect in the procedure of prostate cancerization. By the instruction of this theory, selecting proper marker and detecting its alteration in prostate, clinicians will be able to predict the development of prostate cancer before affirmation of this disease by routine pathological result. It means these patients should be followed closely and carried out more extensive repeat biopsies soon to confirm PCA earlier, while other patients scarcely of this marker in their prostate might possibly be followed less frequently and aggressively. If the confidence of markers reflecting the theory of field effect can be confirmed by further large cohort diagnostic trials, the current situation of prostate cancer diagnosis will be greatly changed.