Predictive Value Of PHI In Prostate Cancer At PSA?4ng/ml

Backgroud and object:With the development of economy,the living standards of the people have been continuously improved,the medical conditions have been improved,people are paying more and more attention to health,and the incidence of prostate cancer has been paid more and more attention,especially in elderly men.It has become an important problem threatening men's health.Although the incidence of prostate cancer in China is still low in the world,the incidence of prostate cancer in some areas of China has leapt to the fifth place in male tumors,and the mortality rate has gradually increased,rising by nearly 50%^[1,2]in some areas.As a serum biomarker for early detection of prostate cancer,PSA is well known and plays an important role in the screening of prostate cancer.In the early 1990s,the introduction of PSA in clinical practice changed the diagnosis and management of prostate cancer,resulting in a continuous reduction in prostate cancer-related mortality^[3].However,PSA is organ specific,not tumor specific.There are many reasons for the increase of PSA,such as prostatitis,benign prostatic hyperplasia,digital rectal examination,acute urinary retention and so on,which lead to many unnecessary biopsy^[4],as a result increasing the financial and psychological burden of patients.The results showed that when tPSA range from 4 to 10 ng/ml,the probability of first detection of prostate cancer was only 22%,and the positive rate of repeated biopsy was only 10%^[5].Therefore,finding new screening methods to improve the detection rate of prostate cancer is one of the important directions to reduce cancer mortality.In the course of exploration,a subtype of PSA precursor,p2PSA,has been found recently.It is mainly derived from the epithelial cells of prostate cancer,especially the peripheral zone of the prostate,which is the predilection site of prostate cancer^[6,7].A number of research institutions have shown that PHI is the most specific in the detection of prostate cancer^[8,9]and is a potential biomarker for prostate cancer screening.The predictive value of PHI in prostate cancer screening was evaluated by comparing PHI with tPSA and fPSA%,when tPSA was at 4-10 ng/ml and tPSA>10ng/ml.Methods:The clinical data of 150 suspected prostate cancer patients in Tianjin Medical University General Hospital from December 2017 to January 2019 were analyzed,including 97 patients with benign prostatic hyperplasia and 53 patients of prostate cancer?the diagnosis of prostate cancer was based on biopsy pathology?.The serum levels of tPSA,fPSA and p2PSA were measured before biopsy,then calculating fPSA%and PHI.According to the value of tPSA,establishing the ROC curves of tPSA,fPSA%and PHI when tPSA is at 4-10 ng/ml and tPSA>10 ng/ml by statistical method.And the diagnostic efficiency of PHI in different PSA segments was obtained.The diagnostic efficacy of each index was compared by Medcalc,evaluat the statistical difference between PHI and other indexes.The best cut-off value of each data was calculated by calculating Jordan index,and the positive predictive value and negative predictive value of each index were obtained.The positive predictive value and negative predictive value of the above indexes were compared,and analyze the predictive value of PHI in prostate cancer screening comprehensively.Results:1.When tPSA was 4-10 ng/ml,there was no significant difference in tPSA level between benign prostatic hyperplasia group and prostate cancer group?P?0.380?,but there was significant difference in fPSA%level?P?0.012?and PHI level?P?0.038?,P<0.05.The ROC curves of tPSA,fPSA%and PHI were established by PHI.The areas under the curves were 0.57,0.72 and 0.70 respectively.The diagnostic efficiency of Medcalc was slightly lower than that of fPSA%,in the diagnosis of PHI and fPSA%.There was no significant difference between the two groups?P?0.614?.When PHI?12.87,fPSA%?0.13,TPSA?7ng/ml,biopasy can obtain the highest prediction accuracy.According to the cut-off value,the positive predictive values of tPSA,fPSA%and PHI were 23.5%,47.1%and 47.1%,respectively.The positive predictive values of fPSA%and PHI were the same.The negative predictive values were 47.9%,77.5%and 88.7%respectively,among which PHI had the highest negative predictive value.2.When tPSA>10 ng/ml,there was no significant difference in fPSA%?P?0.062?and PHI?P?0.714?between benign prostatic hyperplasia group and prostate cancer group,but there was significant difference in tPSA level?P?0.007?.The ROC curves of tPSA,fPSA%and PHI were established by Medcalc,and the areas under the curves were 0.63,0.62 and 0.55 respectively.The diagnostic efficiency of TPSA was the best.The diagnostic efficiency of PHI was lower than that of tPSA and fPSA%,but the difference was not statistically significant?PHI^tPSA P?0.505,PHI^fPSA%P?0.247?.When PHI?3.33,fPSA%?0.16,TPSA?15.09ng/ml,biopasy can obtain the highest prediction accuracy.According to the cut-off value,the positive predictive values of tPSA,fPSA%and PHI were 66.7%,83.3%and 94.4%,respectively.The negative predictive value was 69.2%,46.2%and27.0%,respectively,and the negative predictive value of PHI was the lowest.Conclusion:1.When tPSA was 4-10 ng/ml,the levels of fPSA%?P?0.012?and PHI?P?0.038?in benign prostatic hyperplasia group and prostate cancer group were significantly different,which could be used as a reference in clinical application.The diagnostic efficiency of PHI is slightly lower than that of fPSA%,but the difference is not statistically significant.At present,there is no evidence that PHI can have a better predictive value in prostate biopasy.When PHI?12.87,the negative predictive value is 88.7%,which has some advantages in reducing excessive biopasy.By combining PHI,more people may reduce unnecessary biopasy and avoid excessive medical treatment.2.When tPSA>10 ng/ml,there was no significant difference in PHI?P?0.714?between benign prostatic hyperplasia group and prostate cancer group,but there was significant difference in tPSA level?P?0.007?.The efficacy of tPSA was the highest?0.63?,PHI was the lowest?0.55?by establishing ROC curve.At present,there is no evidence that PHI can have a better predictive value in prostate biopasy.In the segmentation of tPSA>10 ng/ml,the clinical reference significance of tPSA was greater.When PHI?3.33,the positive predictive value is 94.4%,which has some advantages in improving the positive rate of biopsy.More people may avoid missed diagnosis by combining PHI.