Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Investig Clin Urol. 2022 Nov;63(6):631-638. doi: 10.4111/icu.20220056.
The aim of this study was to evaluate the effectiveness of the Prostate Health Index (PHI) and prostate multi-parametric magnetic resonance imaging (mpMRI) in predicting prostate cancer (PCa) and clinically significant prostate cancer (csPCa) during initial prostate biopsy.
In total, 343 patients underwent initial prostate biopsy and were screened by use of PHI and prostate-specific antigen (PSA) levels between April 2019 and July 2021. A subgroup of 232 patients also underwent prostate mpMRI. Logistic regression analysis was performed to evaluate the accuracies of PSA, PHI, and mpMRI as predictors of PCa or csPCa. These predictive accuracies were quantified by using the area under the receiver operating characteristic curve. The different predictive models were compared using the DeLong test.
Logistic regression showed that age, PSA, PHI, and prostate volume were significant predictors of both PCa and csPCa. In the mpMRI subgroup, age, PSA level, PHI, prostate volume, and mpMRI were predictors of both PCa and csPCa. The PHI (area under the curve [AUC]=0.693) was superior to the PSA level (AUC=0.615) as a predictor of PCa (p=0.038). Combining PHI and mpMRI showed the most accurate prediction of both PCa and csPCa (AUC=0.833, 0.881, respectively).
The most accurate prediction of both PCa and csPCa can be performed by combining PHI and mpMRI. In the absence of mpMRI, PHI is superior to PSA alone as a predictor of PCa, and adding PHI to PSA can increase the detection rate of both PCa and csPCa.
本研究旨在评估前列腺健康指数（PHI）和前列腺多参数磁共振成像（mpMRI）在预测初次前列腺活检中前列腺癌（PCa）和临床显著前列腺癌（csPCa）的有效性。
共有 343 例患者于 2019 年 4 月至 2021 年 7 月间接受了初次前列腺活检，并通过 PHI 和前列腺特异性抗原（PSA）水平进行了筛查。其中 232 例患者还接受了前列腺 mpMRI 检查。使用逻辑回归分析评估 PSA、PHI 和 mpMRI 作为 PCa 或 csPCa 预测指标的准确性。使用受试者工作特征曲线下的面积来量化这些预测准确性。使用 DeLong 检验比较不同的预测模型。
逻辑回归显示，年龄、PSA、PHI 和前列腺体积是 PCa 和 csPCa 的重要预测指标。在 mpMRI 亚组中，年龄、PSA 水平、PHI、前列腺体积和 mpMRI 是 PCa 和 csPCa 的预测指标。PHI（曲线下面积 [AUC]=0.693）作为 PCa 的预测指标优于 PSA 水平（AUC=0.615）（p=0.038）。PHI 和 mpMRI 的联合使用对 PCa 和 csPCa 的预测最为准确（AUC=0.833、0.881）。
PHI 和 mpMRI 的联合使用可以对 PCa 和 csPCa 进行最准确的预测。在没有 mpMRI 的情况下，PHI 作为 PCa 的预测指标优于 PSA 单独使用，并且将 PHI 添加到 PSA 中可以提高 PCa 和 csPCa 的检出率。
