Diagnostic value comparison of the combination of prostate-specific membrane antigen-body PET/MR and the prostate health index with each alone in early diagnosis of prostate cancer

ObjectiveThis study aimed to figure out whether the combination of the prostate health index(PHI)and prostate-specific membrane antigen(PSMA)-PET/MR could improve the diagnostic accuracy for prostate cancer(PCa)than that of each individual method used alone.MethodsIn this prospective,observational study,41 patients who underwent the systematic prostate biopsy between June 2019 and September 2022 were enrolled.Both the PHI test and ^(18)F-PSMA-1007-PET/MR were performed prior to biopsies.The diagnostic accuracy of different models was compared by logistic regression,areas under the curve(AUCs)of the receiver operating characteristic,and net reclassification index(NRI).ResultsAmong the 41 patients,14(34.1%)were pathologically diagnosed with PCa.The PHI in the PCa group was significantly higher than that in the benign group(44.4 vs.35.0,p=0.048).Similarly,all the patients in the PCa group received positive results of ^(18)F-PSMA-1007-PET/MR,of which the positive rate was significantly higher than that in benign group(100%vs.62.96%,p=0.025).The ^(18)F-PSMA-1007-PET/MR provided additional diagnostic values to the PHI(AUC:0.802 vs.0.692,p=0.025).However,there was no significant difference between the combination model and the ^(18)F-PSMA-1007-PET/MR alone(AUC 0.802 vs.0.685,p=0.071).The optimal PHI cutoff of the combination model is 32,with which the model could significantly reduce unnecessary biopsies(NRI:22.22%,95%confidence interval:6.54%–37.90%,p=0.005).However,among patients with the PHI of≥43.5,there was no significant difference between the combination model and the PHI alone(NRI:11.11%,95%confidence interval:−0.74%–22.97%,p=0.066).ConclusionThe combination of the PHI and ^(18)F-PSMA-1007-PET/MR outperforms the PHI alone for predicting PCa,especially in avoiding unnecessary biopsies.However,for patients with the PHI of≥43.5,the addition of ^(18)F-PSMA-1007-PET/MR to the PHI does not yield additional benefits.

t-PSA及其衍生指标PHI和PI-RADS评分对前列腺癌诊断效能的评价

目的探讨总前列腺特异性抗原(t-PSA)、游离前列腺特异性抗原(f-PSA)占t-PSA的百分比(f-PSA/t-PSA%)、前列腺健康指数(PHI)和前列腺影像及报告数据系统(PI-RADS)评分对前列腺癌的诊断效能。方法选取2022年7月—2024年2月吉林大学第一医院经病理检查确诊的前列腺疾病患者277例,按病理诊断分为良性疾病组(143例)、前列腺癌组(134例),按t-PSA水平分为t-PSA<20 ng·mL^(-1)组(147例,其中良性疾病100例、前列腺癌47例)、t-PSA≥20 ng·mL^(-1)组(130例,其中良性疾病43例、前列腺癌87例)。检测所有患者血清t-PSA、f-PSA和前列腺特异性抗原同源异构体2(p2PSA),计算f-PSA/t-PSA%,并进行PIRADS评分。采用Logistic回归分析评估前列腺癌发生的影响因素。采用受试者工作特征(ROC)曲线评价各项指标诊断前列腺癌的效能。结果前列腺癌组t-PSA和PHI显著高于良性疾病组(P<0.001),f-PSA/t-PSA%显著低于良性疾病组(P<0.001);PI-RADS评分≥4分所占比例高于良性疾病组(P<0.001)。t-PSA、f-PSA/t-PSA%、PHI和PI-RADS评分诊断前列腺癌的曲线下面积(AUC)分别为0.752、0.633、0.913、0.881。PHI和PI-RADS评分是前列腺癌发生的独立危险因素[比值比(OR)值分别为1.035、2.520,95%可信区间(CI)分别为1.021~1.049、1.672~3.800,P<0.001]。在t-PSA<20 ng·mL^(-1)组中,与良性疾病患者比较,前列腺癌患者PHI和PI-RADS评分≥4分所占比例均显著升高(P<0.001),f-PSA/t-PSA%降低(P<0.05),t-PSA水平差异无统计学意义(P>0.05)。在t-PSA≥20 ng·mL^(-1)组中,与良性疾病患者比较,前列腺癌患者t-PSA水平、PHI和PI-RADS评分≥4分所占比例均显著升高(P<0.001),f-PSA/t-PSA%差异无统计学意义(P>0.05)。t-PSA、f-PSA/t-PSA%、PHI和PI-RADS评分单项检测诊断t-PSA<20 ng·mL^(-1)前列腺癌的AUC分别为0.561、0.611、0.836、0.834;4项指标联合检测的AUC最高,为0.900;单项检测诊断t-PSA≥20 ng·mL^(-1)前列腺癌的AUC分别为0.822、0.520、0.963、0.875,联合检测中t-PSA+f-PSA/t-PSA%+PHI和t-PSA+f-PSA/t-PSA%+PHI+PI-RADS评分的AUC分别为0.970、0.972。结论对于t-PSA<20 ng·mL^(-1)的患者,t-PSA、f-PSA/t-PSA%、PHI和PIRADS评分联合检测可提高前列腺癌的检出率。对于t-PSA≥20 ng·mL^(-1)的患者,PHI是诊断前列腺癌较好的指标,t-PSA、f-PSA/t-PSA%和PHI联合检测可提升诊断效能。

f/t-PSA、PSAD、p2PSA、PHI检测在PI-RADS 2.0评分3分患者中的预测价值

目的:探讨游离/总前列腺特异性抗原(f/t-PSA)比值、前列腺特异性抗原密度(PSAD)、前2肽前列腺特异性抗原(p2PSA)及前列腺健康指数(PHI)在前列腺影像报告和数据系统(PI-RADS)2.0评分为3分的疑似前列腺癌患者中的预测价值。方法:回顾性分析2022年1月—2024年2月于惠州市中心人民医院进行前列腺多参数磁共振成像(mpMRI)检查并接受前列腺穿刺的PI-RADS 2.0评分3分患者60例的病历资料。根据前列腺穿刺结果,将患者分为阳性组和阴性组,各30例。比较两组f/t-PSA、PSAD、p2PSA及PHI水平,并采用受试者工作特征曲线(ROC)分析上述指标对前列腺癌的预测价值。结果:阳性组f/t-PSA、PSAD、p2PSA及PHI水平均高于阴性组(P<0.001);ROC结果显示,f/t-PSA、PSAD、p2PSA及PHI水平预测PI-RADS 2.0评分3分患者发生前列腺癌的AUC分别为0.740、0.684、0.651、0.630;各指标灵敏度、特异度均≥65.00%。结论:在PI-RADS 2.0评分3分的凝似前列腺癌患者中,f/t-PSA、PSAD、p2PSA及PHI检测能在一定程度上反映前列腺癌的风险,可作为前列腺癌筛查的辅助手段。

术前不同PHI水平对前列腺癌诊断及生化复发的影响分析

探讨前列腺特异性抗原同源异构体2(p2PSA)和前列腺健康指数(PHI)对前列腺癌(PCA)诊断的意义,并进一步研究不同水平的术前PHI对PCA生化复发(BCR)的影响。经病理证实的38例PCA和69例良性前列腺增生(BPH)的p2PSA、总前列腺特异性抗原(tPSA),游离前列腺特异性抗原(fPSA),采用受试者工作特征(ROC)曲线下的面积(AUC),评价各项指标诊断PCA的价值。随访术后PCA患者12个月的BCR情况,利用ROC曲线确定PHI的最佳截止值,并将患者分为低PHI组和高PHI组,比较两组的BCR复发率及术前不同水平PHI对术后BCR的影响。对于PSA>4 ng/ml的BPH与PCA患者中,PCA组年龄、tPSA、fPSA、p2PSA和PHI的水平与均高于BPH组,差异有统计学意义(P<0.05)。ROC曲线分析显示,tPSA、p2PSA和PHI诊断PCA的AUC分别为0.637(95%CI:0.529~0.745)、0.731(95%CI:0.630~0.833)、0.845(95%CI:0.770~0.920)。PHI、p2PSA的AUC高于tPSA的AUC,具有更高的诊断价值(AUC>0.7)。高PHI组随访12个月的BCR高于低PHI组,差异有统计学意义(P=0.015)。PHI在PCA的诊断的价值优于目前临床常用的tPSA和fPSA,PHI=71.28可能作为评估PCA术后BCR的临界值,可作为PCA的诊断及术前预测BCR的指标应用于临床。

p2PSA及其相关指标PHI在前列腺癌诊断中的应用价值

目的探讨前列腺特异性抗原同源异构体2(p2PSA)及其相关指标前列腺健康指数(PHI)在前列腺癌诊断中的意义。方法检测50例前列腺癌患者和46例非前列腺癌患者的血清p2PSA、总前列腺特异性抗原(t-PSA)、游离前列腺特异性抗原(f-PSA),计算f-PSA%、p2PSA%和PHI。采用受试者工作特征(ROC)曲线评价各项指标诊断前列腺癌的价值。将前列腺癌患者分为中分化腺癌组(Gleason评分≤7分,32例)和低/未分化癌组(Gleason评分>7分,18例),比较各项指标的差异。结果前列腺癌组年龄、t-PSA、f-PSA%、p2PSA、p2PSA%和PHI与非前列腺癌组比较,差异均有统计学意义(P<0.05),2个组之间f-PSA差异无统计学意义(P>0.05)。ROC曲线分析结果显示,PHI、p2PSA%、p2PSA、f-PSA%和t-PSA诊断前列腺癌的曲线下面积(AUC)分别为0.870、0.837、0.762、0.671、0.652。PHI、p2PSA%对前列腺癌的诊断价值优于f-PSA%和t-PSA。低/未分化癌组f-PSA、p2PSA、f-PSA%和PHI均高于中分化腺癌组(P<0.05),2个组之间p2PSA%及t-PSA差异均无统计学意义(P>0.05)。结论PHI诊断前列腺癌的价值优于目前常用的t-PSA和f-PSA%,可作为前列腺癌的辅助诊断指标应用于临床。

Prostate health index can stratify patients with Prostate Imaging Reporting and Data System score 3 lesions on magnetic resonance imaging to reduce prostate biopsies

We aim to evaluate prostate health index as an additional risk-stratification tool in patients with Prostate Imaging Reporting and Data System score 3 lesions on multiparametric magnetic resonance imaging.Men with biochemical or clinical suspicion of having prostate cancer who underwent multiparametric magnetic resonance imaging in two tertiary centers(Queen Mary Hospital and Princess Margaret Hospital,Hong Kong,China)between January 2017 and June 2022 were included.Ultrasound-magnetic resonance imaging fusion biopsies were performed after prostate health index testing.Those who only had Prostate Imaging Reporting and Data System score 3 lesions were further stratified into four prostate health index risk groups and the cancer detection rates were analyzed.Out of the 747 patients,47.3%had Prostate Imaging Reporting and Data System score 3 lesions only.The detection rate of clinically significant prostate cancer in this group was 15.0%.The cancer detection rates of clinically significant prostate cancer had statistically significant differences:5.3%in prostate health index<25.0,7.4%in prostate health index 25.0-34.9,17.9%in prostate health index 35.0-54.9,and 52.6%in prostate health index≥55.0(P<0.01).Among the patients,26.9%could have avoided a biopsy with a prostate health index<25.0,at the expense of a 5.3%risk of missing clinically significant prostate cancer.Prostate health index could be used as an additional risk stratification tool for patients with Prostate Imaging Reporting and Data System score 3 lesions.Biopsies could be avoided in patients with low prostate health index,with a small risk of missing clinically significant prostate cancer.

Prostate Health Index(phi)and its derivatives predict Gleason score upgrading after radical prostatectomy among patients with low-risk prostate cancer

To analyze the performance of the Prostate Health Index(phi)and its derivatives for predicting Gleason score(GS)upgrading between prostate biopsy and radical prostatectomy(RP)in the Chinese population,an observational,prospective RP cohort consisting of 351 patients from two medical centers was established from January 2017 to September 2020.Pathological reclassification was determined by the Gleason Grade Group(GG).The area under the receiver operating characteristic curve(AUC)and logistic regression(LR)models were used to evaluate the predictive performance of predictors.In clinically low-risk patients with biopsy GG≤2,phi(odds ratio[OR]=1.80,95%confidence interval[95%CI]:1.14-2.82,P=0.01)and its derivative phi density(PHID;OR=2.34,95%CI:1.30-4.20,P=0.005)were significantly associated with upgrading to GG≥3 after RP,and the results were confirmed by multivariable analysis.Similar results were observed in patients with biopsy GG of 1 for the prediction of upgrading to RP GG≥2.Compared to the base model(AUC=0.59),addition of the phi or PHID could provide additional predictive value for GS upgrading in low-risk patients(AUC=0.69 and 0.71,respectively,both P<0.05).In conclusion,phi and PHID could predict GS upgrading after RP in clinically low-risk patients.

前列腺特异性抗原、前列腺健康指数与前列腺癌临床病理特征的相关性分析

目的探讨前列腺特异性抗原(PSA)、前列腺健康指数(PHI)与前列腺癌临床病理特征的相关性。方法选取2020年8月—2023年8月乐山市市中区人民医院收治的80例经活检病理诊断确诊为前列腺癌的患者作为研究对象,将其分为恶性组,另选取同期在乐山市市中区人民医院活检病理诊断确诊为良性前列腺增生的80例患者作为良性组。分别采取两组患者的肿瘤组织进行免疫组化检测,检测PSA表达,并比较其阳性率,并计算PHI,比较其PHI水平。随后分析不同临床病理特征前列腺癌患者的PSA阳性率与PHI水平,并应用logistic回归分析法分析PSA、PHI与前列腺癌临床病理特征的关系。结果两组受检者PSA、PHI表达水平比较,差异有统计学意义(P<0.05)。恶性组患者PSA阳性率和PHI表达水平明显高于良性组,差异有统计学意义(P<0.05);80例前列腺癌患者中,不同年龄、T分期PHI水平比较,差异无统计学意义(P>0.05);不同年龄PSA阳性率比较,差异无统计学意义(P>0.05)。不同淋巴结转移、远处转移、Gleason评分、危险分级患者PHI水平比较,差异有统计学意义(P<0.05);不同T分期、淋巴结转移、远处转移、Gleason评分、危险分级患者PSA阳性率比较,差异有统计学意义(P<0.05)。多因素logistic分析结果表明:T分期、淋巴结转移、远处转移、Gleason评分为PSA阳性表达的危险因素(95%CI:1.259~2.457、1.364~3.475、1.176~4.010、1.036~2.745;P=0.030、0.023、0.016、0.005)。淋巴结转移、远处转移、Gleason评分、危险分级为PHI水平升高的危险因素(95%CI:1.362~3.783、0.826~2.926、1.221~3.525、0.315~1.425;P=0.042、0.031、0.026、0.011)。结论前列腺癌患者的PSA阳性率、PHI表达水平明显升高,且T分期、淋巴结转移、远处转移、Gleason评分为PSA阳性表达的危险因素,淋巴结转移、远处转移、Gleason评分、危险分级为PHI水平升高的危险因素。

Performance of the Prostate Health Index in predicting prostate biopsy outcomes among men with a negative digital rectal examination and transrectal ultrasonography

The [-2]proPSA （p2PSA） and its derivatives, the p2PSA-to-free PSA ratio （%p2PSA）, and the Prostate Health Index （PHI） have greatly improved discrimination between men with and without prostate cancer （PCa） in prostate biopsies. However, little is known about their performance in cases where a digital rectal examination （DRE） and transrectal ultrasonography （TRUS） are negative. A prospective cohort of 261 consecutive patients in China with negative DRE and TRUS were recruited and underwent prostate biopsies. A serum sample had collected before the biopsy was used to measure various PSA derivatives, including total prostate-specific antigen （tPSA）, free PSA, and p2PSA. For each patient, the free-to-total PSA ratio （%fPSA）, PSA density （PSAD）, p2PSA-to-free PSA ratio （%p2PSA）, and PHI were calculated. Discriminative performance was assessed using the area under the receiver operating characteristic curve （AUC） and the biopsy rate at 91% sensitivity. The AUC scores within the entire cohort with respect to age, tPSA, %fPSA, PSAD, p2PSA, %p2PSA, and PHI were 0.598, 0.751, 0.646, 0.789, 0.814, 0.808, and 0.853, respectively. PHI was the best predictor of prostate biopsy results, especially in patients with a tPSA of 10.1-20 ng ml-1. Compared with other markers, at a sensitivity of 91%, PHI was the most useful for determining which men did not need to undergo biopsy, thereby avoiding unnecessary procedures. The use of PHI could improve the accuracy of PCa detection by predicting prostate biopsy outcomes among men with a negative DRE and TRUS in China.

前列腺特异性抗原前体及前列腺健康指数相关参数诊断血清总前列腺特异性抗原灰区前列腺癌患者的临床价值

目的探讨前列腺特异性抗原前体(p2PSA)及前列腺健康指数(PHI)相关参数诊断血清总前列腺特异性抗原(tPSA)灰区前列腺癌(PCa)患者的临床价值。方法选取2019年1月至2023年1月湖州市南浔区人民医院诊治的286例前列腺病变患者作为研究对象,根据病理学结果将其分组为PCa组(n=78)和良性前列腺病变组(n=208)。所有患者入院后均接受前列腺增强磁共振成像(MRI)检查,并测定血清tPSA、游离前列腺特异性抗原(fPSA)和p2PSA水平,计算%fPSA、%p2PSA和PHI参数,绘制受试者工作特征(ROC)曲线分析MRI第2版前列腺影像报告和数据系统(PI-DADS)评分、血清p2PSA、%p2PSA、PHI单项及联合检测对PCa的诊断价值,分析血清p2PSA、%fPSA、%p2PSA、PHI、MRI PI-DADS评分单项及联合检测评估Gleason评分危险度的价值。结果PCa组MRI PI-DADS评分、血清p2PSA、%p2PSA、PHI水平高于良性前列腺病变组(P<0.05)。MRI PI-DADS评分、血清p2PSA、%p2PSA及PHI联合检测诊断PCa的曲线下面积(AUC)为0.961,灵敏度、特异度分别为83.62%、90.66%,诊断效能高于单项检测(P<0.05)。Gleason评分≥7分、Gleason评分≤6分分别有29例、49例。Gleason评分≥7分组MRI PI-DADS评分、血清p2PSA、%p2PSA和PHI高于Gleason评分≤6分组,%fPSA低于Gleason评分≤6分组(P<0.05)。MRI PI-DADS评分、p2PSA、%fPSA、%p2PSA及PHI联合检测评估Gleason评分危险度的AUC为0.928,灵敏度、特异度分别为89.53%、81.24%,评估效能高于单项检测(P<0.05)。结论p2PSA及PHI相关参数可早期诊断PCa的发生,也能进一步提高对侵袭性PCa的诊断效果。

前列腺健康指数联合可溶性上皮钙黏蛋白对前列腺癌的诊断价值

目的分析前列腺健康指数(PHI)联合可溶性上皮钙黏蛋白(sE-cadherin)对前列腺癌(PCa)的诊断价值,为提高疾病检出率的方法研究提供参考。方法选取2018年1月—2023年1月广州医科大学附属第五医院收治的200例良性前列腺增生(BPH)患者作为BPH组,200例PCa患者作为PCa组。将PCa组患者按照不同分期分为Ⅰ~Ⅱ期亚组(n=92)、Ⅲ~Ⅳ期亚组(n=108);按照是否合并骨转移分为无骨转移亚组(n=146)及骨转移亚组(n=54);按照Gleason评分分为≤8分亚组(n=111)及>8分亚组(n=89)。各组均采用酶联免疫吸附法试剂盒检测血清sE-cadherin,采用化学发光分析仪检测总前列腺特异抗原(tPSA)、游离前列腺特异性抗原(fPSA)、前列腺特异性抗原同源异构体2(p2PSA),并根据公式计算PHI。采用受试者工作特征(ROC)曲线分析sE-cadherin联合PHI对PCa的诊断价值。结果与BPH组比较,PCa组患者sE-cadherin、tPSA、p2PSA水平及PHI均升高(P<0.05);与Ⅰ~Ⅱ期PCa患者比较,Ⅲ~Ⅳ期患者的sE-cadherin、tPSA、p2PSA水平及PHI均升高(P<0.05);与无骨转移PCa患者比较,骨转移患者的sE-cadherin、tPSA、p2PSA水平及PHI均升高(P<0.05);与Gleason评分≤8分PCa患者比较,>8分患者的sE-cadherin、tPSA、p2PSA水平及PHI均升高(P<0.05)。sE-cadherin、PHI单独及联合诊断PCa的ROC曲线下面积(AUC)分别为0.719、0.761及0.792,联合诊断AUC最高。结论PCa患者的sE-cadherin水平及PHI均高于BPH,且随着患者分期升高、合并骨转移及Gleason评分的增加而升高,二者联合检测可能有助于提高PCa的诊断效能。

前列腺健康指数与总前列腺特异性抗原在前列腺癌诊断中的多因素及相关性分析

目的:比较前列腺健康指数(PHI)与总前列腺特异性抗原(tPSA)在前列腺癌(Pca)诊断中受临床各因素影响的程度,探讨这些因素与上述指标之间的相关性,旨在为临床医师判断疑似Pca患者是否穿刺活检提供依据。方法:收集自2021年3月至12月于延边大学附属医院接受治疗的82例因tPSA异常而行穿刺活检患者的术前检查资料及其病理检查结果。根据病理结果将数据分为良性组和恶性组,分析前列腺体积(PV)、炎症、膀胱结石、留置导尿管等因素对tPSA以及PHI值的影响,并进一步分析比较了tPSA以及PHI在诊断Pca方面的灵敏度以及特异度。结果:良性组与恶性组tPSA、PHI、PV相比差异均有统计学意义(P<0.05);留置导尿管、泌尿系感染差异无统计学意义(P>0.05)。有无导尿管与tPSA的Spearman相关性为正相关关系(P<0.05);与PHI无相关性(P>0.05)。PV、病理评分与tPSA、PHI的Spearman相关性为正相关关系(P<0.05)。结论:有无导尿管以及PV均影响血清tPSA和PHI值水平,其中PV是影响两者的独立因素,相比之下,PHI受导尿管的干扰较tPSA小。

Prostate volume does not provide additional predictive value to prostate health index for prostate cancer or clinically significant prostate cancer:results from a multicenter study in China

To evaluate whether prostate volume(PV)would provide additional predictive utility to the prostate health index(phi)for predicting prostate cancer(PCa)or clinically significant prostate cancer,we designed a prospective,observational multicenter study in two prostate biopsy cohorts.Cohort 1 included 595 patients from three medical centers from 2012 to 2013,and Cohort 2 included 1025 patients from four medical centers from 2013 to 2014.Area under the receiver operating characteristic curves(AUC)and logistic regression models were used to evaluate the predictive performance of PV-based derivatives and models.Linear regression analysis showed that both total prostate-specific antigen(tPSA)and free PSA(fPSA)were significantly correlated with PV(all P<0.05).[-2]proPSA(p2PSA)was significantly correlated with PV in Cohort 2(P<0.001)but not in Cohort 1(P=0.309),while no significant association was observed between phi and PV.When combining phi with PV,phi density(PHID)and another phi derivative(PHIV,calculated as phi/PV°5)did not outperform phi for predicting PCa or clinically significant PCa in either Cohort 1 or Cohort 2.Logistic regression analysis also showed that phi and PV were independent predictors for both PCa and clinically significant PCa(all P<0.05);however,PV did not provide additional predictive value to phi when combining these derivatives in a regression model(all models vs phi were not statistically significant,all P>0.05).In conclusion,PV-based derivatives(both PHIV and PHID)and models incorporating PV did not improve the predictive abilities of phi for either PCa or clinically significant PCa.

前列腺健康指数、PSAD和血清GPC-3对行前列腺癌根治术患者预后的预测价值

目的研究前列腺健康指数(PHI)、前列腺特异性抗原密度(PSAD)和血清磷脂酰肌醇蛋白聚糖-3(GPC-3)对行前列腺癌根治术患者预后的预测价值。方法回顾性纳入2018年5月至2021年6月在榆林市中医医院接受前列腺癌根治术的80例患者作为研究对象,根据患者术后3年是否发生前列腺癌相关死亡或复发将其分为预后不良组(n=21)和预后良好组(n=59)。比较前列腺癌患者手术前和手术后1周的PHI、PASD和血清GPC-3水平,收集预后不良组和预后良好组的一般临床资料(年龄、体重、身高、肿瘤分期、肿瘤直径、前列腺体积、病理类型、Gleason评分、术切除组织边缘肿瘤细胞染色结果及肿瘤分化程度等),并通过多因素Logistics回归分析确定影响前列腺癌根治术后预后不良的影响因素。通过受试者操作特征(ROC)曲线评估各影响因素对前列腺癌根治术后预后不良的预测价值。结果前列腺癌患者术后的PHI、PASD和血清GPC-3分别为32.61±9.42、0.58±0.18、(15.62±5.37)μg/L,均显著低于术前[41.23±10.56、0.65±0.24、(26.95±5.71)μg/L],差异均有统计学意义(P<0.05)。单因素和多因素Logistics回归分析显示,TNM分期高、切缘阳性、肿瘤低分化、术后PHI高、术后PSAD高以及术后GPC-3高是前列腺癌根治术后预后不良的独立危险因素(P<0.05)。ROC曲线分析显示:术后PHI、术后PSAD和术后GPC-3预测前列腺癌根治术后预后不良的曲线下面积分别为0.803、0.730和0.847,最佳横截面值分别为28.50、16.50和0.575μg/L。结论前列腺癌根治术后高PHI、高PSAD和高血清GPC-3是前列腺癌患者术后预后不良的独立危险因素,三者对前列腺根治术后预后不良均较高的预测价值。

前列腺健康指数对PI-RADS-3病变前列腺癌的诊断价值

目的探讨前列腺健康指数(prostate health index,PHI)及其衍生指标在前列腺多参数核磁中PI-RADS-3病变的前列腺癌中的诊断价值。方法回顾性分析石家庄市人民医院2019至2022年204例前列腺特异性抗原(PSA)检测值异常病并行超声引导下前列腺活检的患者数据,将155例良性前列腺增生的患者作为良性前列腺增生组,49例前列腺癌患者作为前列腺癌组。收集2组患者临床数据,利用受试者工作特征(ROC)曲线评价不同亚组中总前列腺特异性抗原(TPSA)、游离/总前列腺特异性抗原(%fPSA)、PHI、前列腺健康指数密度(PHID)和总前列腺特异性抗原密度(PSAD)对于前列腺癌的诊断价值。结果49例患有前列腺癌中81.63%的病例诊断为临床显著性前列腺癌(csPCa)。2组年龄、前列腺体积(PV)、TPSA和PSAD差异无统计学意义(P>0.05)。前2肽前列腺特异性抗原(p2PSA)、PHI和PHID比较,差异均有统计学意义(P<0.05)。与TPSA相比,PHI(AUC=0.786,95%CI:0.705~0.867)和PHID(AUC=0.763,95%CI:0.684~0.843)是前列腺癌更好的预测指标。TPSA、%fPSA、p2PSA、PHI、PHID和PSAD区域在csPCa组的ROC曲线面积分别为0.587、0.650、0.696、0.823、0.796和0.614。所有参数中PHI和PHID对于前列腺癌的预测结果最准确。结论在PI-RADS-3病变的情况下,相较于传统指标,前列腺健康指数及其衍生指标为前列腺癌的检出提供了最佳的诊断价值。

加味千金地肤子汤治疗肾虚湿热型慢性前列腺炎/慢性盆腔疼痛综合征合并弱精症的临床观察

目的探讨采用加味千金地肤子汤治疗慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)合并弱精症的临床疗效。方法选取2020年7月至2021年12月于珠海市中西医结合医院就诊的86例肾虚湿热型CP/CPPS合并弱精症患者作为研究对象,随机分为治疗组(n=44)和对照组(n=42)。对照组给予西药常规治疗,治疗组在对照组的基础上给予加味千金地肤子汤治疗。比较两组临床疗效、治疗前后的中医证候评分及精液质量。结果经12周治疗后,治疗组总体有效率(88.6%)高于对照组(66.7%),美国国立卫生研究院慢性前列腺炎症状指数(NIH-CPSI)评分、中医证候评分、精子DNA碎片率(DFI)显著低于对照组,平均尿流率(AFR)、最大尿流率(MRF)、精子总活力(PR+NP)、精子顶体酶活性显著高于对照组(P<0.05)。结论加味千金地肤子汤联合西药治疗可改善肾虚湿热型CP/CPPS合并弱精症患者的排尿困难、骨盆疼痛、性功能及精子活力下降等症状。

The combined role of MRI prostate and prostate health index in improving detection of significant prostate cancer in a screening population of Chinese men

Using prostate-specific antigen(PSA)for prostate cancer(PCa)screening led to overinvestigation and overdiagnosis of indolent PCa.We aimed to investigate the value of prostate health index(PHI)and magnetic resonance imaging(MRI)prostate in an Asian PCa screening program.Men aged 50–75 years were prospectively recruited from a community-based PSA screening program.Men with PSA 4.0–10.0 ng ml^(−1) had PHI result analyzed.MRI prostate was offered to men with PSA 4.0–50.0 ng ml−1.A systematic prostate biopsy was offered to men with PSA 4.0–9.9 ng ml^(−1) and PHI≥35,or PSA 10.0–50.0 ng ml^(−1).Additional targeted prostate biopsy was offered if they had PI-RADS score≥3.Clinically significant PCa(csPCa)was defined as the International Society of Urological Pathology(ISUP)grade group(GG)≥2 or ISUP GG 1 with involvement of≥30%of total systematic cores.In total,12.8%(196/1536)men had PSA≥4.0 ng ml^(−1).Among 194 men with PSA 4.0–50.0 ng ml^(−1),187(96.4%)received MRI prostate.Among them,28.3%(53/187)had PI-RADS≥3 lesions.Moreover,7.0%(107/1536)men were indicated for biopsy and 94.4%(101/107)men received biopsy.Among the men received biopsy,PCa,ISUP GG≥2 PCa,and csPCa was diagnosed in 42(41.6%),24(23.8%),and 34(33.7%)men,respectively.Compared with PSA/PHI pathway in men with PSA 4.0–50.0 ng ml^(−1),additional MRI increased diagnoses of PCa,ISUP GG≥2 PCa,and csPCa by 21.2%(from 33 to 40),22.2%(from 18 to 22),and 18.5%(from 27 to 32),respectively.The benefit of additional MRI was only observed in PSA 4.0–10.0 ng ml^(−1),and the number of MRI needed to diagnose one additional ISUP GG≥2 PCa was 20 in PHI≥35 and 94 in PHI<35.Among them,45.4%(89/196)men with PSA≥4.0 ng ml^(−1) avoided unnecessary biopsy with the use of PHI and MRI.A screening algorithm with PSA,PHI,and MRI could effectively diagnose csPCa while reducing unnecessary biopsies.The benefit of MRI prostate was mainly observed in PSA 4.0–9.9 ng ml^(−1) and PHI≥35 group.PHI was an important risk stratification step for PCa screening.

前列腺特异性抗原同源异构体2及其衍生指标在预测前列腺癌病理分级中的价值

目的:探讨血清前列腺特异性抗原同源异构体2(isoform[-2]proprostate-specific antigen,p2PSA)及经计算得到的%p2PSA和前列腺健康指数(prostate health index,PHI)等指标预测前列腺癌(prostate cancer,PCa)病理分级的价值。方法:回顾性入组了322例来自北京大学第一医院在2015年8月至2018年5月期间就诊的PCa患者,其中143例为进行经直肠超声引导的前列腺穿刺活检证实的PCa患者,179例为进行PCa根治术的患者。采用全自动免疫分析仪DxI800检测患者的术前预留血清中前列腺特异性抗原(total prostate-specific antigen,tPSA)、游离前列腺抗原(free prostate antigen,fPSA)、fPSA/tPSA比值(f/t)、p2PSA水平,并计算得到%p2PSA和PHI,以术后病理结果确定Gleason评分,采用受试者工作曲线(receiver operating characteristic curve,ROC)比较p2PSA、%p2PSA及PHI与传统指标tPSA、fPSA和f/t预测高级别前列腺癌(Gleason评分≥7)的价值。结果:Gleason评分≥7患者的p2PSA、%p2PSA和PHI的中位数水平均高于Gleason评分<7患者(p2PSA:30.22 ng/L vs.18.33 ng/L;%p2PSA:2.50 vs.1.27;PHI:91.81 vs.35.44;P值均<0.01)。%p2PSA和PHI预测高级别PCa的曲线下面积(area under curve,AUC)为0.770和0.760,高于传统指标tPSA、fPSA和f/t(AUC分别为0.648,0.536和0.693)。进行前列腺穿刺术证实为PCa的患者中,PHI和%p2PSA预测高级别PCa的价值(AUC分别为0.801和0.808)明显高于tPSA、fPSA和f/t(AUC分别为0.729,0.655和0.665)。进行PCa根治术后的患者中,PHI和%p2PSA预测高级别PCa的价值(AUC分别为0.798和0.744)也有高于其他传统指标tPSA、fPSA和f/t(AUC分别为0.625,0.507和0.697)的趋势。结论:与传统指标tPSA、fPSA和f/t相比,p2PSA的衍生指标%p2PSA和PHI对于高级别PCa具有更高的预测价值,可以帮助临床评估PCa治疗方案,为患者及时制定更合适的诊疗策略。

慢性前列腺炎综合征病人NIH-CPSI问卷分析

目的 :探讨NIH CPSI对慢性前列腺炎综合征的临床价值。 方法 :应用NIH CPSI问卷 ,随机对 2 2 7例慢性前列腺炎综合征 (CPS) /慢性盆腔疼痛综合征 (CPPS ,包括ⅢA和ⅢB)和 32例良性前列腺增生 (BPH)进行观察。结果 :①CPS病人的主要症状表现为疼痛或不适 ,明显多于BPH病人 ;② 79.30 %CPS病人有排尿不尽 ,而排尿后 2h以内又有尿意为 4 4 .93% ;③ 5 1.5 1%CPS病人因慢性前列腺炎症状影响工作 ,90 .31%的病人影响业余生活 ,6 8.72 %的病人影响生活质量 ,与BPH病人比较 ,明显影响CPS病人的生活质量。 结论 :应用NIH CPSI问卷观察CPS ,表明CPS病人的主要症状是疼痛或不适 。

中药熏蒸联合盐酸左氧氟沙星治疗ⅢA型前列腺炎(湿热瘀滞证)的临床疗效研究

目的:观察中药熏蒸联合盐酸左氧氟沙星治疗ⅢA型前列腺炎(湿热瘀滞证)的临床疗效。方法:将72例ⅢA型前列腺炎(湿热瘀滞证)患者随机分成两组,其中治疗组36例,对照组36例。治疗组采取中药熏蒸联合盐酸左氧氟沙星胶囊口服治疗,对照组单纯使用盐酸左氧氟沙星胶囊口服治疗。治疗4周后,对比两组疗效及治疗前后美国国立卫生研究院慢性前列腺炎症状指数(NIH-CPSI)、中医症状评分、最大尿流率(Qmax)、平均尿流率(Qave)的变化情况。结果:治疗组总有效率(91.7%)显著高于对照组(61.1%),差异有统计学意义(P<0.01)。总NIH-CPSI:治疗组治疗后为(14.5±8.2)分,显著低于治疗前的(26.5±9.3)分和对照组治疗后的(20.6±7.9)分,P均<0.05;对照组治疗前后差异无显著性[(27.1±9.1)分vs(20.6±7.9)分,P>0.05]。Qmax:对照组治疗前后无明显改变[(15.4±3.4)ml/s vs(16.1±2.9)ml/s,P>0.05],治疗组治疗后显著高于治疗前[(21.2±4.3)ml/s vs(15.8±3.6)ml/s,P<0.05],也显著高于对照组治疗后水平。Qave:对照组治疗前后也无明显改变[(10.9±2.4)ml/s vs(11.1±2.9)ml/s,P>0.05],治疗组治疗后显著高于治疗前[(16.3±3.5)ml/s vs(10.5±2.8)ml/s,P<0.05],也显著高于对照组治疗后水平。结论:中药熏蒸联合盐酸左氧氟沙星能明显改善ⅢA型前列腺炎(湿热瘀滞证)患者的症状,降低其NIH-CPSI,同时提高患者的Qmax及Qave,可作为ⅢA型前列腺炎(湿热瘀滞证)的一种有效治疗方法。