亞洲族群以攝護腺健康指數合併多參數磁振造影診斷攝護腺癌
李瑋涓1、謝博帆1,4、林維卿2,4、張菡3、張兆祥1、黃志平1,4、楊啟瑞1、陳汶吉1、張議徽1、吳錫金4,5
中國醫藥大學附設醫院 1泌尿部，2醫學影像部，3病理部；4中國醫藥大學 醫學系 泌尿學科；5中國醫藥大學附設醫院北港分院 泌尿部
Combining prostate health index and multiparametric magnetic resonance imaging in the diagnosis of clinically significant prostate cancer in an Asian population
Wei-Juan Li1, Po-Fan Hsieh1,4, Wei-Ching Lin2,4, Han Chang3, Chao-Hsiang Chang1, Chi-Ping Huang1,4 Chi-Rei Yang1, Wen-Chi Chen1, Yi-Huei Chang1, Hsi-Chin Wu4,5
Department of 1Urology, 2Radiology and 3Pathology, China Medical University Hospital, Taichung, Taiwan
4Department of Urology, China Medical University Beigang Hospital, Beigang, Yunlin, Taiwan
5School of Medicine, China Medical University, Taichung, Taiwan
Purpose:
To evaluate the practicability of combining Prostate Health Index (PHI) and multiparametric magnetic resonance imaging (mpMRI) for detection of clinically significant prostate cancer (csPC) in an Asian population.
Materials and Methods:
We prospectively enrolled patients who underwent prostate biopsy due to elevated serum prostate-specific antigen (PSA >4 ng/mL) and/or abnormal digital rectal examination (DRE) in a tertiary referral center. Before prostate biopsy, the serum samples were tested for PSA, free PSA, and p2PSA to calculate PHI. Besides, mpMRI was performed using a 3-T scanner and reported in the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2). The diagnostic performance of PHI, mpMRI, and combination of both were assessed.
Results:
Among 102 subjects, 39 (38.2%) were diagnosed with PC, including 24 (23.5%) with csPC (Gleason ≥7). By the threshold of PI-RADS ≥3, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to predict csPC were 100%, 37.2%, 32.9%, and 100%, respectively. By the threshold of PHI ≥30, the sensitivity, specificity, PPV, and NPV to predict csPC were 91.7%, 43.6%, 33.3%, and 94.4%, respectively. The area under the receiver operator characteristic curve of combining PHI and mpMRI were greater than that of PHI alone (0.864 vs. 0.735, p =0.002) and mpMRI alone (0.864 vs. 0.811, P=0.029). If biopsy was restricted to patients with PI-RADS 5 as well as PI-RADS 3 or 4 and PHI 30, 48% of biopsy could be avoided with one csPC patient being missed.
Conclusion:
The combination of PHI and mpMRI had higher accuracy for detection of csPC compared with PHI or mpMRI alone in an Asian population.