攝護腺健康指數密度用於預測接受根除性攝護腺切除手術台灣人族群的病理結果
黃裕賓1、林子平1,2、魏子鈞1,2、黃奕燊1,2、范玉華1,2、林志傑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、張延驊1,2、林登龍1,2、黃志賢1,2
台北榮民總醫院 泌尿部1；國立陽明大學醫學院 泌尿學科 書田泌尿科學研究中心2
Prostate health index density predicts aggressive pathological outcomes after radical prostatectomy in Taiwanese patients
Yu-Pin Huang1, Tzu-Ping Lin1,2,*, Tzu-Chun Wei1,2, Yi-Shen Huang1,2,
Yu-Hua Fan1,2,Chi-Chieh Lin1,2, Eric Y.H. Huang1,2, Hsiao-Jen Chung1,2,
Junne-Yih Kuo1,2, Howard H.H. Wu1,2, Shing-Hwa Lu1,2, Yen-Hwa Chang1,2,
Alex T.L. Lin1,2, William J.S. Huang1,2
1Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan;
2Department of Urology, School of Medicine, and Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan
Purpose:
There are models to predict pathological outcomes based on established clinical and prostatic specific antigen (PSA)-derived parameters, however they are not satisfactory. p2PSA and its derived biomarkers have shown promise for the diagnosis and prognosis of prostate cancer. The aim of this study was to investigate whether p2PSA-derived biomarkers can assist in the prediction of aggressive pathological outcomes after radical prostatectomy.
Material and Methods:
We prospectively enrolled patients who were diagnosed with prostate cancer and treated with radical prostatectomy (RP) between February 2017 and December 2018. Pre-biopsy blood samples were analyzed for tPSA, free PSA (fPSA), percentage of fPSA (%fPSA), [-2]proPSA (p2PSA) and percentage of p2PSA (%p2PSA). PHI was calculated as (p2PSA/fPSA) x √tPSA. Prostate volume was determined by transrectal ultrasound using the ellipsoid formula, and PHI density was calculated as PHI/prostate volume. The areas under the receiver operating characteristic curve were estimated for various PSA/p2PSA derivatives. Aggressive pathological outcomes measured after radical prostatectomy were defined as pathological T3 or a Gleason score (GS) more than 6 as determined in radical prostatectomy specimens.
Results:
One hundred and forty-four patients were included for analysis. Postoperative GS was more than 6 in 86.1% of the patients, and pT stage was T3a or more in 54.2%. Among all PSA- and p2PSA-derived biomarkers, PHI density was the best biomarker to predict aggressive pathological outcomes after RP. Furthermore, the odds ratio of having an aggressive pathological outcome of RP was 8.796 (p=0.001).
Conclusions:
PHI density may further aid in predicting aggressive pathological outcomes after RP. This biomarker may be useful in preoperative counseling and may have potential in decision making when choosing between definitive treatment and active surveillance of newly diagnosed prostate cancer.
Keywords:
Prostate-specific antigen [2]proPSA, Prostate health index density, Prostate cancer, Radical prostatectomy