The Clinical Research Of Prostate Health Index In Predicting Prostate Cancer In The PSA Gray Zone

Objective:To explore the performance of prostate health index(PHI)in the diagnosis of prostate cancer in patients who underwent initial prostate biopsy with serum total prostate specific antigen(PSA)in gray zone and normal digital rectal examination.Methods:A total of 90 patients(PSA in gray zone,normal digital rectal examination)who underwent transperineal initial prostate biopsy under the guidance of rectal ultrasound at the Department of Urology of the First Hospital of Shanxi medical university from September 2019 to December 2020 were selected.The differences in diagnostic performance of t PSA,%f PSA,p2 PSA,PHI and PHID in the prostate cancer group and the non-prostate cancer group were compared.Taking the pathological results of prostate biopsy as the gold standard,the receiver operating characteristic curves of t PSA,%f PSA,p2 PSA,PHI,PHID were drawn and the value in the area under the curves of these biomarkers were compared.With the 89.5% diagnostic sensitivity,the diagnostic specificities of different tumor markers were further evaluated.In addition,in patients diagnosed with prostate cancer,the values of these tumor markers in the diagnosis of clinically significant prostate cancer were further evaluated.Results:Among the 90 study subjects,19 patients(21.1%)were diagnosed with prostate cancer by prostate biopsy.The medians of t PSA,%f PSA,p2 PSA,PHI,and PHID in the prostate cancer group were 6.42ng/ml,16.38%,17.05 ng/L,39.67 and 1.03 respectively,and in the non-prostate cancer group the medians of t PSA,%f PSA,p2 PSA,PHI and PHID were 6.30ng/ml,19.80%,11.20ng/L,26.23 and 0.59.Comparing the values of the tumor markers between the prostate cancer group and the non-prostate cancer group,the results showed that p2 PSA,PHI,and PHID were significantly different between the two groups(P<0.05).The area under the curve for diagnosis of prostate cancer by t PSA,%f PSA,p2 PSA,PHI,and PHID are 0.523,0.593,0.697,0.809 and 0.807 respectively,indicating that the ability to diagnose prostate cancer of PHI is similar with PHID in the gray zone of PSA which is better than other tumor markers.When the diagnostic sensitivity is set to 89.5%,the diagnostic specificity of PHI was 57.7%,which is better than traditional tumor markers.Appropriately sacrificing diagnostic sensitivity and improving diagnostic specificity,the best cut-off value of PHI was 31.09,which can avoid 52 cases of unnecessary prostate biopsy.In the prostate cancer group,11 cases were diagnosed Gleason Score≥7 points.The mean value of PHI was 49.16;8 cases were diagnosed Gleason Score=6 points.The mean value of PHI was 32.39 and the difference between the two groups was significant(P=0.006).Conclusion:The PHI value has obvious value for the early diagnosis of prostate cancer.In the gray zone of PSA,the performance of PHI is similar to PHID in the early diagnosis of prostate cancer,and is better than traditional tumor markers.When the PHI value is 31.09,the diagnosis effect is the best,and 52 cases of unnecessary prostate biopsy can be avoided.In addition,there is a correlation between PHI value and clinically significant prostate cancer,which can predict the risk of prostate cancer to some extent.