攝護腺健康指數改善初次切片攝護腺癌診斷率
台灣男性攝護腺特定抗原介於4-10ng/ml研究
1,2,3吳錫金、1謝博帆、1,3張兆祥、1楊啟瑞、1,3黃志平、1,4陳汶吉、1葉進仲、1,3鄒頡龍、
1,3陳國樑、1連啟舜、1陳冠亨、1蕭博任
1中國醫藥大學附設醫院泌尿部，2中國醫藥大學北港附設醫院泌尿科，3中國醫藥大學醫學系，4中國醫藥大學中西醫結合研究所
Prostate health index (PHI) improve prostate cancer detection at initial biopsy in Taiwanese men with PSA 4-10ng/ml
1,2,3Hsi-Chin Wu, 1Po-Fan Hsieh, 1,3Chao-Hsiang Chang, 1Chi-Rei Yang, 1,3Chi-Ping Huang, 1,4Wen-Chi Chen, 1Jin-Jung Ye, 1,3Chieh-Lung Chou, 1,3 Kuo-Liang Chen, 1 Chi-Shun Lien, 1Guang-Heng Chen, 1Po Jen Hsiao
1Department of Urology, China Medical University Hospital, Taichung, Taiwan；
2Division of Urology, China Medical University Beigang Hospital, Yunlin,
3School of Medicine, China Medical University , 4Graduate institute of integrated Medicine
Purpose: To test the performance of serum isoform〔-2〕proPSA derivatives and the PHI in the detection of prostate cancer (Pca) in Taiwanese men with PSA 4-10ng/ml receiving their first prostate biopsy.
Materials and Methods: This prospective study included 106 patients ( age 65.0±7.5 yrs) with PSA 4-10ng/ml who underwent transrectal ultrasound guided 12-core prostate biopsies between April 2016 and March 2017. Total PSA (tPSA), free PSA (fPSA) and〔-2〕proPSA (p2PSA) were determined before biopsy. The % fPSA, %p2PSA (p2PSA/fPSA), and PHI ( p2PSA/fPSA The urologist didnot know the data before bx. The performance of p2PSA derivatives was analyzed using logistic regression and area under the receiver operating curves (AUC).
Results: Twenty three (21.7%) Pca were diagnosed. Seventeen of them (73.9%) was HG Pca ( Gleason score 7 or above). Statistically significant differences between Pca and noncancer patients were found for age (p=0.016), %fPSA (p=0.022), p2PSA (p=0.018), %p2PSA(18.1 vs 11.8, p<0.001) and PHI ( 45.6 vs 28.8, p<0.001). The AUC for tPSA, fPSA, %fPSA, p2PSA, %p2PSA and PHI were 0.56, 0.34, 0.30, 0.58, 0.77 and 0.80 respectively. HG Pca had higher PHI (49.5) than grade 6 patients (34.3) but without statistically difference. At a PHI sensitivity of 90%, a total of 32 (31%) biopsies could have been avoided.
Conclusions: PHI improved the accuracy of Pca detection in Taiwanese men with PSA 4-10ng/ml receiving their first prostate biopsy.