Возможность использования индекса PCA3 без массажа предстательной железы в моче для диагностики рака предстательной железы

Background. Prostate cancer holds one of the leading positions among malignant neoplasms in men. One of the most well-studied tumor-specific maskers is the PCA3 score in urine obtained after prostate massage. However, the study of the PCA3 score without prostate massage can significantly simplify the preanalytical phase of the study and minimize discomfort for the patient.Objective. Investigation of the diagnostic significance of PCA3, determined in urine sediment without prostate massage and its comparison with the PCA3 score after prostate massage.Materials and methods. The study included 2 groups of patients. In the first group (n = 50), the PCA3 score was assessed without prostate massage, and in the second group (n = 15) PCA3 was assessed in urine obtained before and after massage.Results. The area under the ROC-curve (AUC) for the PCA3 score without prostate massage was 0.722 (95 % confidence interval 0.579—0.865; p = 0.008). Using the ROC analysis, the threshold value, sensitivity and specificity were determined: 25, 72.41 % (95 % confidence interval 54.28— 85.30 %) and 57.14 % (95 % confidence interval 36.55—75.53 %), respectively. The PCA3 score after massage was found to be more sensitive than without prostate massage. A small volume of material, less than 20 ml, significantly affects the sensitivity of PCA3 without massage.Conclusion. PCA3 without prostate massage may serve as an option to improve the early diagnosis of prostate cancer, but its advantage over PCA3 after prostate massage has not been shown.Введение. Рак предстательной железы занимает одну из лидирующих позиций среди злокачественных новообразований у мужчин. Одним из наиболее хорошо изученных опухолеспецифических маркеров является индекс PCA3 в моче, полученной после проведения массажа предстательной железы. Однако исследование индекса РСА3 без предварительного массажа предстательной железы может существенно упростить преаналитический этап исследования и минимизировать дискомфорт для пациента.Цель исследования — изучение диагностической значимости индекса РСА3, определяемого в осадке мочи без проведения массажа предстательной железы, и его сравнение с индексом PCA3 после массажа.Материалы и методы. В исследование включены 2 группы пациентов. В 1-й группе (n = 50) проводилась оценка индекса PCA3 без массажа предстательной железы, во 2-й группе (n = 15) — оценка индекса PCA3 в моче, полученной до и после массажа.Результаты. Площадь под ROC-кривой (AUC) для индекса PCA3 без массажа предстательной железы составила 0,722 (95 % доверительный интервал 0,579—0,865;p = 0,008). С помощью ROC-анализа были определены пороговое значение 25, чувствительность 72,41 % (95 % доверительный интервал 54,28—85,30 %) и специфичность 57,14 % (95 % доверительный интервал 36,55— 75,53 %). Индекс PCA3 после массажа оказался более чувствительным, чем без проведения массажа предстательной железы. Малый объем материала (<20 мл) значительно влияет на чувствительность индекса PCA3 без массажа.Заключение. Индекс PCA3 без массажа может служить опцией для улучшения ранней диагностики рака предстательной железы, однако не было показано его преимущества перед индексом PCA3 после массажа предстательной железы

Diagnostic value of PCA3, TMPRSS2:ERG and prostatic specific antigen derivatives in the detection of prostate cancer

Background. Prostate cancer (PCa) is one of the most common malignancy in men. A traditional marker in the laboratory diagnosis ofPCa is the prostatic specific antigen (PSA). However, the low specificity of this marker leads to a large number of unnecessary biopsies. The emergence of various modifications of PSA and tumor-specific genetic markers such as PCA3 and TMPRSS2ERG, have improved the diagnosis of PCa.Objective. Investigation of the diagnostic significance of molecular genetic markers, PCA3 and TMPRSS2:ERG, and their comparison with markers based on PSA isoforms: free/total PSA ratio (%fPSA) and prostate health index (PHI).Materials and methods. The study included 58 men with suspected PCa. All patients were defined PCA3 score and the presence of TMPRSS2:ERG fusion transcript in the urine sediment. Also, PHI and %fPSA were determined in 48 and 51 men, respectively.Results. The area under the ROC-curve regardless of the value of PSA was higher for PCA3 score (0.773, p <0.001), than for %fPSA and PHI: 0.625 (p = 0.131) and 0.735 (p = 0.006), respectively. At clinical sensitivity >95 % PCA3 score had the highest specificity, positive and negative predictive values in men, regardless of the level of PSA: 65.22, 80.95, and 93.75 %, respectively. In men with PSA level of 2—10 ng/ml the area under the ROC-curve for PCA3, %fPSA and PHI was 0.776 (p = 0.001), 0.629 (p = 0.144) and 0.729 (p = 0.009), respectively. At high sensitivity (>95 %) characteristics of the diagnostic test PCA3 in men with a PSA level of 2—10 ng/ml also also exceeded those for PHIand %>fPSA. The negative predictive valuefor PCA3score in this group ofmen was 100 %. The sensitivity ofdetection ofthe TMPRSS2:ERG fusion transcript in urine was 37.14 %, specificity 86.96 %, and the positive predictive value was 81.25 %.Conclusion. The use ofthe PCA3 score in combination with the detection of TMPRSS2:ERG fusion will improve the assessment of PCa risk in men with PSA levels between 2 and 10ng/ml (the “grey zone”)

Lipid profile in hospitalized patients with COVID-19 depending on the outcome of its acute phase: data from the international registry "Dynamics analysis of comorbidities in SARS-CoV-2 infection survivors"

Aim. To study the lipid profile in hospitalized patients with coronavirus disease 2019 (COVID-19) depending on the outcome of its acute phase according to the AKTIV international registry.Material and methods. The AKTIV registry included men and women over 18 years of age with a diagnosis of COVID-19, who were treated in a hospital. A total of 9364 patients were included in the registry, of which 623 patients were analyzed for levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides on days 1-2 of hospitalization. The level of high-density lipoprotein cholesterol (HDL-C) was calculated using the Friedewald equation.Results. We found that a decrease in LDL-C level was significantly associated with an unfavorable prognosis for hospitalized patients with COVID-19. This pattern persisted in both univariate and multivariate analyses. LDL-C levels in the final multivariate model had a significant relationship with the prognosis (an increase in the death risk by 1,7 times with a decrease per 1 mmol/l). In addition, we found that the survival of patients with an indicator level of <2,45 mmol/l is significantly worse than in patients with an LDL-C level ≥2,45 mmol/l. All patients with high LDL-C ((≥4,9 mmol/l) survived, while among patients with low LDL-C (<2,45 mmol/l. All patients with high LDL-C ((≥4,9 mmol/l) survived, while among patients with low LDL-C (<1,4 mmol/l), mortality was 13,04%, which was significantly higher than in patients with LDL-C ≥1,4 mmol/l (6,32%, p=0,047).Conclusion. A decrease in LDL-C in the acute period is significantly associated with an unfavorable prognosis for hospitalized patients with COVID-19. Determination of LDL-C can be included in the examination program for patients with COVID-19. However, the predictive value of this parameter requires further study in prospective clinical studies