蔣智宏^1,2、洪健華²、黃昭淵²

¹臺北榮民總醫院員山分院 泌尿外科

²臺灣大學附設醫院 泌尿部

Public Chinese Prostate Cancer Professional Series-1：Accurate Diagnosis of Prostate Cancer (translated from NCCN Prostate Cancer Guidelines 2023 V1)

Chih-Hung Chiang^1,2、Jian‑Hua Hong²、Chao‑Yuan Huang²

¹ Department of Urology, Taipei Veterans General Hospital, Yuan-Shan Branch；

² Departments of Urology, National Taiwan University Hospital

Purpose：There are few specialized Chinese series on prostate cancer (PCa). This article is completely translated into Chinese according to the NCCN PCa Guideline Version 1. 2023. It is hoped that through the clear and easy-to-understand professional Chinese PCa series introduction, patients and their families can get the most correct and complete understanding from accurate biopsy diagnosis to the latest PCa treatment methods.

Materials and Methods：This section is translated from the NCCN Guidelines Versions 1. 2023 of Prostate Cancer Early Detection. Compared with PSA, there are 2 blood markers, 4 urine markers and multiparametric MRI (mpMRI), all of which can diagnose PCa more accurately and effectively. Only two examinations available in Taiwan are discussed here：Prostate Health Index (PHI) and mpMRI.

Results：American guidelines recommend that men aged 45-75 be screened for PSA. If the PSA of a normal-risk male (such as an Asian) is £ 1、1-3 and > 3 ng/ml, it is recommended to check PSA every 2-4 years、every 1-2 years and consider Pre-prostate biopsy (PBx) procedure, respectively. Arranging PBx for Asian men with PSA 4.0 - 10.0 ng/ml + PHI >35 increases the positive diagnosis rate of high-grade PCa by 8.6 times (2.5% => 21.5%) and reduce unnecessary "transrectal systematic PBx" up to 71%. For mpMRI PI-RADS 3/4/5 lesions, the positive rates of "transperineal target PBx" for high-grade PCa were 26%/58%/81% (average up to 66%).

Conclusion：PHI and mpMRI, alone or in combination, are more accurate than PSA in diagnosing (high-grade) PCa.