Prostate health index and prostate cancer gene 3 score but not percent-free Prostate Specific Antigen have a predictive role in differentiating histological prostatitis from PCa and other nonneoplastic lesions (BPH and HG-PIN) at repeat biopsy
Prostate health index and prostate cancer gene 3 score but not percent-free Prostate Specific Antigen have a predictive role in differentiating histological prostatitis from PCa and other nonneoplastic lesions (BPH and HG-PIN) at repeat biopsy
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DOI：
10.1016/j.urolonc.2015.05.032
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发表时间：
2015-10-01
影响因子：
2.7
通讯作者：
Porpiglia, Francesco
中科院分区：
文献类型：
--
作者：
De Luca, Stefano;Passera, Roberto;Porpiglia, Francesco
目的：为了确定前列腺健康指数（PHI）、前列腺癌抗原基因3（PCA 3）评分和游离前列腺特异性抗原（%fPSA）百分比是否可用于区分无症状急性和慢性前列腺炎与前列腺癌（PCa）、良性前列腺增生（BPH）、高级别前列腺上皮内瘤（HG-PIN）在PSA水平升高且重复活检时直肠指检（re-Bx）阴性的患者中。患者和方法：在这项前瞻性研究中，入组了252例患者，在重新Bx前接受了PHI、PCA 3评分和%fPSA评估。我们使用3个多变量logistic回归模型来检验PHI、PCA 3评分和%fPSA作为前列腺炎与PCa、BPH和HG-PIN的危险因素。所有分析均针对整个患者队列和PSA（4-10 ng/ml）的“灰色区”队列（171名个体）进行。活检阴性和活检阳性的男性之间的中位Pill（34.9 vs. 48.1，P < 0.001）、PCA 3评分（24 vs. 54，P < 0.001）和%fPSA（11.8% vs. 15.8%，P = 0.012）存在显著差异。使用PCA 3和Pill区分前列腺炎和PCa的净效益是中等的，尽管它扩展到了一个良好的阈值概率范围。（40%-100%），而使用%fPSA的结果可以忽略不计：对于整个人群报告的这种模式与“灰色地带”PSA队列一样。在区分阴性活检与阳性活检的所有3种生物标志物的良好诊断性能之前，使用PCA 3评分和PHI估计前列腺炎与PCa的临床获益相当。PHI是前列腺炎与BPH的唯一决定因素，而没有生物标志物可以区分前列腺炎症与HG-PIN。(C)2015爱思唯尔公司All rights reserved.
Objective: To determine if prostate health index (PHI), prostate cancer antigen gene 3 (PCA3) score, and percentage of free prostate specific antigen (%fPSA) may be used to differentiate asymptomatic acute and chronic prostatitis from prostate cancer (PCa), benign prostatic hyperplasia (BPH), and high-grade prostate intraepithelial neoplasia (HG-PIN) in patients with elevated PSA levels and negative findings on digital rectal examination at repeat biopsy (re-Bx).Patients and methods: In this prospective study, 252 patients were enrolled, undergoing PHI, PCA3 score, and %fPSA assessments before re-Bx. We used 3 multivariate logistic regression models to test the PHI, PCA3 score, and %fPSA as risk factors for prostatitis vs. PCa, vs. BPH, and vs. HG-PIN, All the analyses were performed for the whole patient cohort and for the "gray zone" of PSA (4-10 ng/ml) cohort (171 individuals).Results: Of the 252 patients, 43 (17.1%) had diagnosis of PCa. The median Pill was significantly different between men with a negative biopsy and those with a positive biopsy (34.9 vs. 48.1, P < 0.001), as for the PCA3 score (24 vs. 54, P < 0.001) and %fPSA (11.8% vs. 15.8%, P = 0.012). The net benefit of using PCA3 and Pill to differentiate prostatitis and PCa was moderate, although it extended to a good range of threshold probabilities (40%-100%), whereas that from using %fPSA was negligible: this pattern was reported for the whole population as for the "gray zone" PSA cohort.Conclusion: In front of a good diagnostic performance of all the 3 biomarkers in distinguishing negative biopsy vs. positive biopsy, the clinical benefit of using the PCA3 score and PHI to estimate prostatitis vs. PCa was comparable. PHI was the only determinant for prostatitis vs. BPH, whereas no biomarkers could differentiate prostate inflammation from HG-PIN. (C) 2015 Elsevier Inc. All rights reserved.