攝護腺健康指數(PHI)與％p2PSA在地區教學醫院診斷攝護腺癌的初步經驗
吳美姬1,2 林素珠2 蔣智宏2,3
1臺北榮民總醫院員山分院 護理部 專科護理師
2臺北榮民總醫院員山分院 泌尿科/教學研究中心
3臺灣大學附設醫院 泌尿部
Initial experience of Prostate Health Index (PHI) and %p2PSA on prostate cancer diagnosis value in a regional teaching hospital
Mei-Chi Wu1,2 Su-Chu Lin2 Chih-Hung Chiang2,3
1 Department of Nursing, Taipei Veterans General Hospital, Yuan-Shan Branch, Yi-Lan, Taiwan
2 Department of Urology / Medical and Research, Taipei Veterans General Hospital, Yuan-Shan Branch, Yi-Lan, Taiwan
3 Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
Purpose: Prostate specific antigen (PSA) with low specificity that causes unnecessary prostate biopsies increases clinical morbidities, psychological stress, and medical expenses. We aimed to validate the p2PSA% and Prostate Health Index (PHI) for the detection of prostate cancer
Material and Methods: We prospectively enrolled 106 men aged 45-91 years between January 2017 and December 2018 who underwent prostate biopsy with PSA ³ 4.0 ng/ml or abnormal findings on digital rectal examination and exclusion patients with active urinary tract infection or acute prostatitis. Total PSA (tPSA), free PSA (fPSA), and p2PSA levels were measured by serum samples before prostate biopsy. PHI was calculated as (p2PSA/fPSA)√tPSA. Logistic regression analyses were used to predict the risk of cancer and detect clinically significant prostate cancer.
Results: 28(26.4%) patients were confirmed with the diagnoses of prostate cancer by prostate biopsy. The levels of p2PSA, %p2PSA, and PHI showed statistically significant differences between prostate cancer patients and non-cancer patients. %p2PSA and PHI had the highest area under the receiver operating characteristic curve (AUC) of 0.808 and 0.888 (both p < 0.001), respectively, predicting cancer detection at biopsy than other predictors (tPSA, fPSA, %fPSA, and P2PSA% (AUC: 0.774, 0.561, 0.151, and 0.716, respectively).
Conclusion: %p2PSA and PHI increased the diagnostic accuracy with significantly greater sensitivity and specificity than tPSA with serum PSA 4 ng/mL.