NPD64: Nontraumatic Page kidney– A case report and literature review
攝護腺健康指數可幫助磁振造影影像灰色地帶病灶(PI-RADS 3)的攝護腺癌診斷
蘇楷森1、林子平1,2、顧明軒1,2、陳威任1,2、黃子豪1,2、魏子鈞1,2、黃奕燊1,2、
范玉華1,2、林志杰1,2、黃逸修1,2、鍾孝仁1,2、郭俊逸1,2、張延驊1,2、林登龍1,2、黃志賢1,2
1臺北榮民總醫院泌尿部；2國立陽明交通大學醫學院泌尿學科及書田泌尿科學研究中心
Prostate Health Index (PHI) Aids Prostate Cancer Detection in the Grey Zone of MRI- (PI-RADS 3) Lesions
Kai-Sen Su1, Tzu-Ping Lin1,2, Ming-Hsuan Ku1,2, Wei-Ren Chen1,2, Tzu-Hao Huang1,2,
Tzu-Chun Wei1,2, I-shen Huang1,2, Yu-Hua Fan1,2, Chih-Chieh Lin1,2, Eric Yi-Hsiu Huang1,2,
Hsiao-Jen Chung1,2, Junne-Yih Kuo1,2, Yen-Hwa Chang1,2, Alex T.L. Lin1,2,
William J.S. Huang1,2
1 Department of Urology, Taipei Veterans General Hospital;
2 Department of Urology, College of Medicine and Shu-Tien Urological Science Research Center, National Yang Ming Chiao Tung University
Purpose: Multiparametric magnetic resonance imaging (mpMRI) can identify areas of the prostate that suggest cancer. This allows for targeted biopsies to be performed on suspicious areas, while avoiding unnecessary biopsies in men with no suspicious lesions. The role and necessity of targeted biopsy towards Prostate Imaging–Reporting and Data System (PI-RADS) 3 lesions are still yet to be determined, with only around 20% clinically significant prostate cancer (csPCa) diagnosed through biopsy. To further stratify csPCa from other diagnoses, we hereby aim to test the performance of serum biomarkers in improving the diagnosis of csPCa from PI-RADS 3 image findings.
Materials and Methods: We prospectively enrolled patients with PI-RADS 3 lesions detected by mpMRI, who further underwent MRI/Transrectal ultrasound (MRI‑TRUS) fusion prostate biopsies at Taipei Veterans General Hospital (VGHTPE) from May 2017 to December 2022. Serum biomarkers, including prostate-specific antigen (PSA), free PSA and [-2]proPSA (p2PSA) were collected. Prostate health index (PHI) was calculated by serum biomarkers mentioned above. Prostate volume was also measured by TRUS to generate PSA density (PSAD). We excluded patients with known prostate cancer, those using 5-alpha reductase inhibitors, those with a prior history of transurethral resection of the prostate (TURP), and those who had mpMRI or serum biomarkers tested after the biopsy. Clinically significant prostate cancer was defined as Gleason grade group ≥ 2. Receiver operating characteristic (ROC) curves were drawn to determine the diagnostic power of PSA derivatives. Youden index was used for cutoff value calculation.
Results: 59 patients with PI-RADS 3 lesions underwent MRI‑TRUS fusion prostate biopsy at our institute. The median age was 65.4 years, and the median PSA was 8.33 ng/mL. 20 patients were diagnosed with prostate cancer, and 13 patients were diagnosed with clinically significant prostate cancer. Among all biomarkers, PSAD had good performance in predicting total PCa (AUC 0.0.715, 95% CI 0.583–0.848) and csPCa (AUC 0.689, 95% CI 0.534–0.844), while PHI had the best performance in predicting total PCa (AUC 0.799, 95% CI 0.680–0.918) and csPCa (AUC 0.814, 95% CI 0.692–0.937). Using a cutoff value of PHI of 48.53 calculated by the Youden index, unnecessary biopsies could be avoided in 43 (72.9%) patients, while only 4 (6.8%) cases with csPCa would be missed.
Conclusion: In men with PI‑RADS 3 lesions undergoing MRI‑TRUS fusion prostate biopsies, PHI was the best PSA‑derived biomarker to predict csPCa. PHI level of 48.53 was identified as the best cutoff value for csPCA detection in our experience.