Prostat Kanserinde Tümör Belirteçleri.
Özet
Prostat kanseri, erkeklerde en sık görülen üriner sistem malignitesi olup, erken tanı, prognoz tayini ve tedavi sonrası takip süreçlerinde klinik öneme sahip hastalıkların ayırt edilmesi için biyobelirteçlere ihtiyaç duymaktadır. En yaygın kullanılan organa özgü belirteç Prostat Spesifik Antijen (PSA) olsa da, kansere özgü olmaması ve benign hastalıklarda da yükselmesi nedeniyle kısıtlılıklara sahiptir. Bu sınırlılıkları aşmak adına PSA yoğunluğu, hızı, ikilenme zamanı ve serbest/total PSA oranı gibi parametreler kullanılmaktadır. Ayrıca, gereksiz biyopsileri önlemek ve agresif seyirli kanserleri yakalamak amacıyla PHI, 4Kscore, IsoPSA ve Proclarix gibi kan temelli; PCA3, Exosome Dx, SelectMDx ve MiPS gibi idrar temelli yeni nesil biyobelirteçler geliştirilmiştir. Doku düzeyinde ise ConfirmMDx, OncotypeDx, Decipher ve Prolaris gibi testler epigenetik ve RNA ekspresyon analizleriyle nüks ve mortalite riskini öngörmektedir. EAU, AUA ve NCCN kılavuzları da bu testlerin biyopsi kararlarında ve takibinde belirli kriterlerle kullanılmasını önermektedir. Sonuç olarak, bu gelişmiş belirteçler aşırı tedaviyi ve maliyetleri azaltmada kritik rol oynamaktadır.
Prostate cancer is the most common urinary tract malignancy in men, necessitating the use of biomarkers for early diagnosis, prognosis determination, and distinguishing clinically significant disease during post-treatment follow-up. Although Prostate-Specific Antigen (PSA) is the most widely utilized organ-specific marker, it possesses limitations due to its lack of cancer specificity, as it can also elevate in benign conditions. To overcome these constraints, parameters such as PSA density, velocity, doubling time, and free/total PSA ratios are employed. Furthermore, to prevent unnecessary biopsies and detect aggressive cases, blood-based biomarkers like PHI, 4Kscore, IsoPSA, and Proclarix, alongside urine-based liquid biopsies including PCA3, Exosome Dx, SelectMDx, and MiPS, have been developed. At the tissue level, tests such as ConfirmMDx, OncotypeDx, Decipher, and Prolaris predict recurrence and mortality risks through epigenetic and RNA expression analyses. International guidelines, including EAU, AUA, and NCCN, recommend utilizing these markers under specific criteria for biopsy decision-making. Ultimately, these advanced serum, urine, and tissue-based biomarkers play a critical role in improving diagnostic accuracy while reducing over-treatment and associated healthcare costs.
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