Department of Urology, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Taipei, 11217, Taiwan.
Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Sci Rep. 2021 Mar 5;11(1):1286. doi: 10.1038/s41598-020-78428-6.
To evaluate the performance of the Prostate Health Index (PHI) in magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion prostate biopsy for the detection of clinically significant prostate cancer (csPCa). We prospectively enrolled 164 patients with at least one Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) ≥ 3 lesions who underwent MRI-TRUS fusion prostate biopsy. Of the PSA-derived biomarkers, the PHI had the best performance in predicting csPCa (AUC 0.792, CI 0.707-0.877) in patients with PI-RADS 4/5 lesions. Furthermore, the predictive power of PHI was even higher in the patients with PI-RADS 3 lesions (AUC 0.884, CI 0.792-0.976). To minimize missing csPCa, we used a PHI cutoff of 27 and 7.4% of patients with PI-RADS 4/5 lesions could have avoided a biopsy. At this level, 2.0% of cases with csPCa would have been missed, with sensitivity and NPV rates of 98.0% and 87.5%, respectively. However, the subgroup of PI-RADS 3 was too small to define the optimal PHI cutoff. PHI was the best PSA-derived biomarker to predict csPCa in MRI-TRUS fusion prostate biopsies in men with PI-RADS ≥ 3 lesions, especially for the patients with PI-RADS 3 lesions who gained the most value.
评估前列腺健康指数（PHI）在磁共振成像-经直肠超声（MRI-TRUS）融合前列腺活检中检测临床显著前列腺癌（csPCa）的性能。我们前瞻性地招募了 164 名至少有一个前列腺成像报告和数据系统版本 2（PI-RADS v2）≥3 病变的患者，他们接受了 MRI-TRUS 融合前列腺活检。在 PSA 衍生的生物标志物中，PHI 在 PI-RADS 4/5 病变患者中预测 csPCa 的性能最佳（AUC 0.792，CI 0.707-0.877）。此外，在 PI-RADS 3 病变患者中，PHI 的预测能力更高（AUC 0.884，CI 0.792-0.976）。为了最大限度地减少遗漏的 csPCa，我们使用 PHI 截断值为 27，7.4%的 PI-RADS 4/5 病变患者可以避免活检。在这个水平上，将遗漏 2.0%的 csPCa 病例，其敏感性和阴性预测值分别为 98.0%和 87.5%。然而，PI-RADS 3 亚组太小，无法确定最佳的 PHI 截断值。PHI 是预测 PI-RADS≥3 病变患者 MRI-TRUS 融合前列腺活检中 csPCa 的最佳 PSA 衍生生物标志物，尤其是对 PI-RADS 3 病变患者最有价值。
