前列腺健康指數對於主動監測前列腺癌在預測核磁共振造影分期的價值:
台灣前瞻性的研究結果
蔣智宏1,2，鄭詠庭1，蒲永孝1，黃昭淵1
國立台灣大學附設醫院 泌尿部1, 台北榮民總醫院員山分院 泌尿部2
The value of prostate health index to predict magnetic resonance imaging lesions during active surveillance:
A prospective cohort in Taiwan
Chih-Hung Chiang1,2, Yung-Ting Cheng1, Yeong-Shiau Pu1, Chao-Yuan Huang1
Department of Urology, National Taiwan University Hospital1, Department of Urology, Taipei Veterans General Hospital Yuanshan Branch2
Abstract
Purpose
Active surveillance reduces overtreatment in patients with low-risk prostate cancer. Identification of aggressive tumor is essential to prompt active treatment. Multi-parametric MRI (mpMRI) remains an important tool during follow up due to its high negative predictive value to detect clinically significant cancers. We aimed to evaluate the impact of prostate Health Index (PHI) on radiological finding in patients with active surveillance.
Materials and Methods
We prospectively enrolled 26 patients diagnosed as low-risk prostate cancer in active surveillance program from National Taiwan University Hospital. Total PSA, free PSA, p2PSA levels and Prostate Health Index (PHI) were measured to investigate the correlation with clinical and radiological staging. Patients with more prominent tumors detected by mpMRI than digital rectal examination were considered as up-reclassification group.
Results
Nine (34.6 %) patients were classified as up-reclassification group due to more prominent cancers detected by mpMRI compared with digital rectal examination. Median PHI among overall population was 31. %p2PSA, and PHI were statistically significantly higher in up-reclassification group than non-reclassification groups (both p=0.045). In multivariate logistic regression analysis, PHI shows predictive significance in upgrading cancer stage by mpMRI (odds ratio 1.15, 95% CI [1.01-1.31], p=0.037).
Conclusions
%p2PSA and PHI may add predictive value to upgrade cancer staging by radiological finding during active surveillance. Pathological validation is warranted to characterize the accuracy of progression detection.