攝護腺健康指數與切片結果及根除性攝護腺切除後病理分期的關聯性

李宗叡、吳錫金、謝博帆、張兆祥、楊啟瑞、黃志平、陳汶吉

中國醫藥大學附設醫院 泌尿部

Real world experience of prostate health index in CMUH: its correlation with biopsy outcomes, and pathological stage after radical prostatectomy

Tzung-Ruei Li, His-Chin Wu, Po-Fan Hsieh, Chao-Hsiang Chang, Chi-Rei Yang, Chi-Ping Huang, Wen-Chi Chen

Department of Urology, China Medical University Hospital, Taichung, Taiwan

Purpose: The aim of this study is to validate the feasibility of Prostate Health Index (PHI) in diagnostic performance, predication of biopsy Gleason score and pathological variables in Taiwan cohort.

Materials and Methods:

Our cohort recruited 101 patients between March 2018 and December 2018 whose PHI were initially checked and further received transrectal ultrasound guided biopsy. The primary outcome was the comparison of diagnostic performance of various PSA derivatives (total PSA, free PSA, p2PSA, and PHI) to predict prostate cancer. The secondary outcome were the comparison of PSA derivatives between patients with Gleason Score 6 and≧7, and analyzed the pathological variables between PHI by logistic regression in the radical prostatectomy group. All statistical analysis was performed with SPSS 22.0. ROC analysis was used for estimating the AUCs.

Results: 35 (34.7%) patients were diagnosed prostate cancer, and 22 (63%)of them was high grade (Gleason score≧7). Our cohort showed statistically significant differences between cancer and non-cancer patients in age (p=0.012), p2PSA (p=0.005), and PHI (p=0.001). The best area under the curve value was achieved by PHI (0.733) (total PSA 0.596, p2PSA 0.684) in differentiating cancer and non-cancer patients. Subgroup of Biopsy Gleason score≧7 had significantly higher PHI than those of Gleason score 6 (73.39 vs 46.55, p=0.049). 17 patients (48.6%) of the cancer group received radical prostatectomy. Among the clinical variables including Prostate Cancer Prevention Trial(PCPT), positive cores numbers and PHI, higher PHI would best indicate pathological T3a by multivariate logistic regression.

Conclusions:

Prostate Health Index outperforms other derivatives in the detection of prostate cancer and could be used as a predictor of high grade prostate cancer in Taiwanese population. PHI correlates significantly with the pathological T stage.