前列腺健康指數密度相較於前列腺抗原更能顯著增加前列腺癌診斷的正確性
邱士庭1， 鄭詠庭1，蔣智宏1,2，蒲永孝1，陳忠信1，劉詩彬1，呂育全1，張奕凱1，周博敏1，張宏江1，黃國皓1，李苑如1，姜宜妮1，洪士鈞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
Prostate health index density significantly improves the accuracy of clinically significant prostate cancer detection than prostate specific antigen
Chiu Shih Ting1, Yung-Ting Cheng1, Chih-Hung Chiang1,2, Yeong-Shiau Pu1, Chung-Hsin Chen1, Shih Ping Liu1, Yu-Chuang Lu1, Yi-Kai Chang1, Po-Ming Chow1, Hong-Chiang Chang1, Kuo-How Huang1, Yuan-Ju Lee1, I-Ni Chiang1, Shih-Chun Hung1, Chao-Yuan Huang1
Department of Urology, National Taiwan University Hospital1
Department of Urology, Taipei Veterans General Hospital Yuanshan Branch2
Purpose
Prostate health index (PHI) is a promising biomarker in prediction aggressive prostate cancer. Since prostate volume has been regarded as an important factor contributed to elevated prostate-specific antigen (PSA), PSA density is widely used to predict the presence of prostate cancer. We aim to assess the efficacy of PHI density in predicting prostate cancer in men undergoing transrectal ultrasound-guided prostate biopsy (TRUSP biopsy).
Materials and Methods
We prospectively enrolled 505 men who underwent TRUSP biopsy for suspected prostate cancer. Total PSA, free PSA, p2PSA levels were measured by serum samples before the prostate biopsy. PHI was calculated as ((p2PSA/fPSA) × √tPSA). PHI density (PHID) was calculated by diving PHI by the prostate volume. Receiver operating characteristic curve (ROC curve) and multivariable logistic regression analyses were used to predict the risk of cancer detection and clinically significant prostate cancer.
Results
The detection rate of prostate cancer was 33.1% (167/505). 65.8% (110/167) of the cancer patients were found to have Gleason score ≥7 disease. Prostate volume, total PSA, free PSA, p2PSA, p2PSA%, and PHI in cancer cases were significantly higher than the non-cancer patients. The median PHI in both cancer and non-cancer men were 50.93 and 29.79, respectively; whereas the PHID were 1.61 and 0.58, respectively. PHID had the highest area under the ROC curve (AUC) in predicting the presence of prostate cancer and clinically significant cancer than other predictors (0.806 and 0.865, both p<0.001). At a threshold of 0.71, PHID had a sensitivity 91.7% and a specificity 59.3% for clinically significant cancer. In multivariable logistic regression, age, prostate volume, total PSA and PHID were significant predictors of clinically significant cancer.
Conclusions
Utilizing prostate volume adds discriminative value to PHI in predicting clinical significant prostate cancer. Unnecessary biopsies could be avoided by using PHID as an alternative to PSA test.