Use of the Prostate Health Index for detection of prostate cancer: results from a large academic practice.
Use of the Prostate Health Index for detection of prostate cancer: results from a large academic practice.
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DOI：
10.1038/pcan.2016.72
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发表时间：
2017-06
影响因子：
4.8
通讯作者：
Ross AE
中科院分区：
文献类型：
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作者：
Tosoian JJ;Druskin SC;Andreas D;Mullane P;Chappidi M;Joo S;Ghabili K;Agostino J;Macura KJ;Carter HB;Schaeffer EM;Partin AW;Sokoll LJ;Ross AE
前列腺健康指数（phi）在诊断前列腺癌（PCa）方面优于PSA和其他PSA衍生物。phi测试在现实世界的临床环境中的影响尚未被评估。在一个单一的大型学术中心，在345名接受PCa诊断评估的患者中测试了phi。前瞻性记录前列腺活检（包括分级组[GG]，定义为GG 1：Gleason评分[GS] 6，GG 2：GS 3+4=7，GG 3：GS 4+3=7，GG 4：GS 8和GG 5：GS 9-10）、磁共振成像（MRI）和根治性前列腺切除术（RP）的结果。将活检率和结局与未进行phi测试的当代队列（n=1318）进行比较。总体而言，39%的phi检测男性接受前列腺活检。没有phi<19.6的男性被诊断为PCa，只有3名phi<27的男性患有GG≥2的癌症。Phi在预测前列腺活检的任何PCa（AUC 0.72 vs. 0.47）和GG≥2 PCa（AUC 0.77 vs. 0.53）方面上级PSA。在接受MRI和phi检查的男性中，phi<27且PI-RADS≤3的男性没有GG≥2的癌症。对于那些进展到RP的男性，phi增加与较高的病理GG（p=0.002）和分期（p=0.001）相关。与未进行phi检测的患者相比，使用phi检测的患者前列腺活检率降低了9%（39% vs. 48%; p<0.001）。重要的是，phi人群中活检的减少继发于阴性（8%）和GG 1（1%）活检发生率的降低，而检测到GG≥2癌症的活检比例保持不变。在这项大规模的实时临床经验中，phi优于单独的PSA，与高级别PCa相关，并为MRI提供了补充信息。将phi纳入临床实践减少了不必要的活检率，而没有改变更高级别癌症的检测频率。
The Prostate Health Index (phi) outperforms PSA and other PSA derivatives for the diagnosis of prostate cancer (PCa). The impact of phi testing in the real-world clinical setting has not been previously assessed. In a single, large, academic center, phi was tested in 345 patients presenting for diagnostic evaluation for PCa. Findings on prostate biopsy (including Grade Group [GG], defined as GG1: Gleason score [GS] 6, GG2: GS 3+4=7, GG3: GS 4+3=7, GG4: GS 8, and GG5: GS 9-10), magnetic resonance imaging (MRI), and radical prostatectomy (RP) were prospectively recorded. Biopsy rates and outcomes were compared to a contemporary cohort that did not undergo phi testing (n=1318). Overall, 39% of men with phi testing underwent prostate biopsy. No men with phi<19.6 were diagnosed with PCa, and only 3 men with phi<27 had cancer of GG≥2. Phi was superior to PSA for the prediction of any PCa (AUC 0.72 vs. 0.47) and GG≥2 PCa (AUC 0.77 vs. 0.53) on prostate biopsy. Among men undergoing MRI and phi, no men with phi<27 and PI-RADS≤3 had GG≥2 cancer. For those men proceeding to RP, increasing phi was associated with higher pathologic GG (p=0.002) and stage (p=0.001). Compared to patients who did not undergo phi testing, the use of phi was associated with a 9% reduction in the rate of prostate biopsy (39% vs. 48%; p<0.001). Importantly, the reduction in biopsy among the phi population was secondary to decreased incidence of negative (8%) and GG1 (1%) biopsies, while the proportion of biopsies detecting GG≥2 cancers remained unchanged. In this large, real-time clinical experience, phi outperformed PSA alone, was associated with high-grade PCa, and provided complementary information to MRI. Incorporation of phi into clinical practice reduced the rate of unnecessary biopsies without changing the frequency of detection of higher grade cancers.