對歐洲亞洲攝護腺健康指數（PHI）診斷攝護腺癌的多中心評估：PHI ≧ 30/35似乎是台灣人tPSA 4-10 ng/ml時建議攝護腺切片的理想標準
蔣智宏1,2 黃昭淵2
1臺北榮民總醫院員山分院 泌尿科/教學研究中心
2臺灣大學附設醫院 泌尿部
A Multicentre Evaluation of the Role of the Prostate Health Index (PHI) in Regions with Differing Prevalence of Prostate Cancer：PHI 30/35 seems to be the suitable standard to suggest prostate biopsy in Taiwanese with tPSA 4-10 ng/ml
Chih-Hung Chiang1,2 Chao-Yuan Huang2
1 Department of Urology / Medical and Research, Taipei Veterans General Hospital, Yuan-Shan Branch, Yi-Lan, Taiwan
2 Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
Purpose: Asians have a lower incidence of prostate cancer (PC). Adjustment of PHI reference ranges is needed for European and Asian settings.
Material and Methods: We compared the performance of the Prostate Health Index (PHI) for 2488 men in different ethnic groups (1688 Asian and 800 European men from 9 sites) with PSA 2-20ng/ml and PHI test and transrectal ultrasound-guided biopsy results available. Of these, 1652 men had PSA 2-10ng/ml and a normal digital rectal examination and underwent initial biopsy. The proportions of PC (Gleason ≥6) and higher-grade PC (HGPC, Gleason ≥7) across different PHI ranges were compared. The performance of PSA and PHI was compared using the area under the receiver operating characteristic curve (AUC) and decision curve analyses (DCA).
Results: Among Asian men, PC/HGPC would be diagnosed in 5.0%/1.0%, 7.5%/1.9%, 26.0%/13%, and 44.0%/30% of men using PHI thresholds of <25, 25-35, 35-55, and >55, respectively. With PHI > 35, 71% of unnecessary biopsies and 46% of low grade (Gleason 6) PC diagnoses could have been avoided. However, it may miss diagnosed 18% high grade (Gleason ≥7) PC with PHI > 35. At 90% sensitivity for PC diagnosis (PHI >30), 56% of unnecessary biopsies and 33% of low grade (Gleason 6) PC diagnoses could have been avoided. Under PHI > 30, only 11% high grade (Gleason ≥7) PC will be missed.
Conclusion: PHI 30/35 seems to be the suitable standard to suggest prostate biopsy in Taiwanese with tPSA 4-10 ng/ml