「攝護腺健康指數」在懷疑攝護腺癌病患上的運用-台北榮民總醫院之經驗
潘柏勳1、林子平1,2、魏子鈞1,2、黃奕燊1,2、林志杰1,2、黃逸修1,2、
鍾孝仁1,2、郭俊逸1,2、吳宏豪1,2、盧星華1,2、黃志賢1,2、張延驊1,2、林登龍1,2
1台北榮民總醫院 泌尿部; 2陽明大學醫學院泌尿學科及書田泌尿學研究中心
To Evaluate the Application of The Prostate Health Index (PHI) in Suspected Prostate Cancer Patients- experience of Taipei Veterans General Hospital
Po-Hsun Pan1, Tzu-Ping Lin1,2, Tzu-Chun Wei1,2,
Yi-Shen Huang1,2, Chi-Cheh Lin1,2 , Eric Y.H. Huang1,2,
Hsiao-Jen Chung1,2, Junne-Yih Kuo1,2, Howard H.H. Wu1,2
Shing-Hwa Lu1,2, William J.S. Huang1,2, Yen-Hwa Chang1,2, Alex T.L. Lin1,2
1Department of Urology, Taipei Veterans General Hospital;
2Department of Urology, School of Medicine, and Shu-Tien Urological Institute,
National Yang-Ming University, Taipei, Taiwan
Purpose: Prostate-specific antigen (PSA) has been widely used as a serum marker for prostate cancer (PCa) detection or progression monitoring, which dramatically increased rate of early detection while significantly reduced PCa-specific mortality. However, due to low specificity, it caused many overtreatment and unnecessary prostate biopsy. Recently, prostate health index, derived from total PSA (tPSA), free PSA(fPSA) and p2PSA was found to have higher accuracy rate to distinguish malignancy from benign disease. In this study, we aimed to confirm if PHI is a better biomarker for prostate cancer detection comparing with PSA and free PSA in Taiwanese population.
Materials and Methods: This is a prospective study at Taipei Veterans General Hospital to develop a data-set containing those who will receive transrectal ultrasound-guided prostate(TRUSP) biopsy due to elevated tPSA > 4.0 ng/ml. Total PSA, free PSA and P2PSA was checked by Beckman-Coulter(Access 2, immunoassay system). Biopsy proved prostate cancer was used as end-point. Statistical analyses were performed for the sensitivity, specificity and ROC curve for each marker in predicting the biopsy proved prostate cancer..
Results: 155 patients were enrolled, TRUSP biopsy identified prostate cancer in 59 patients (37.3%), which 96 men (60.8%) did not. Total PSA (p=0.00), P2PSA percentage (p= 0.002), and PHI (p= 0.002) were higher in patients who were diagnosed to have cancer, free PSA percentage (p= 0.006) was higher in non-cancer patients. On ROC analysis, PHI (AUC: 0.751) also gave a better result for distinguish cancer from non-prostate cancer patients compared with total PSA (AUC: 0.558).
Conclusion: Consistent with previous report, PHI had better predictive power in TRUSP biopsy proved prostate cancer in patients whose tPSA was between 4 and 10 ng/mL