血清前列腺特异性抗原(prostate-specific antigen, PSA)这一血清标志物目前已被广泛运用到前列腺癌(prostate cancer, PCa)的筛查和诊断,但对于血清总前列腺特异性抗原(total prostate-specific antigen 2, tPSA)处于4～10 ng/mL诊断灰区的前列腺癌,其诊断意义有限。为提高了前列腺癌患者PSA处于灰区时的诊断率,减少不必要的有创穿刺操作,本文就前列腺特异性抗原同源异构体2(prostate-specific antigen isoform 2, p2PSA)及前列腺健康指数(prostate health index, PHI)对于早期有临床意义前列腺癌(clinically significant prostate cancer, csPCa)诊断的临床应用价值,与前列腺癌的侵袭性,以及对于前列腺癌患者的疾病进展、预后、复发等方面都具有潜在的作用进行论述。近些年,多参数磁共振成像(mpMRI)也成为了预测csPCa的常用工具,使用MRI和PHI相互补充可用于检测早期有临床意义的前列腺癌。
[1] Li J, Wang K, Li S, et al. Clinical study of multifactorial diagnosis in prostate biopsy[J]. Prostate, 2023, 83(15): 1494-1503.
[2] Falagario UG, Lantz A, Jambor I, et al. Diagnosis of prostate cancer with magnetic resonance imaging in men treated with 5-alpha-reductase inhibitors[J]. World J Urol, 2023, 41(11): 2967-2974.
[3] Nguyen DD, Wallis CJD, Fleshner NE, et al. Urologic oncology survivorship guidelines: an overview of the evidence and the current implementation gap[J]. Eur Urol Focus, 2023, 9(3): 431-434.
[4] Chen R, Sjoberg DD, Huang Y, et al. Prostate specific antigen and prostate cancer in Chinese men undergoing initial prostate biopsies compared with western cohorts[J]. J Urol, 2017, 197(1): 90-96.
[5] 黄健. 中国泌尿外科和男科疾病诊断治疗指南: 2019版[M]. 北京: 科学出版社, 2020.
[6] 孙颖浩. 吴阶平泌尿外科学[M]. 北京: 人民卫生出版社, 2019: 3350-3357.
[7] Lee CU, Lee SM, Chung JH, et al. Clinical utility of prostate health index for diagnosis of prostate cancer in patients with PI-RADS 3 lesions[J]. Cancers (Basel), 2022, 14(17): 4174.
[8] Yáñez-Castillo YM, Melgarejo-Segura MT, Funes-Padilla C, et al. Prostate health index (PHI) as an accurate prostate cancer predictor[J]. J Cancer Res Clin Oncol, 2023, 149(11): 9329-9335.
[9] Gentile F, Ferro M, Della Ventura B, et al. Optimized identification of high-grade prostate cancer by combining different PSA molecular forms and PSA density in a deep learning model[J]. Diagnostics, 2021, 11(2): 335.
[10] Black MH, Magklara A, Obiezu C, et al. Expression of a prostate-associated protein, human glandular kallikrein (hK2), in breast tumours and in normal breast secretions[J]. Br J Cancer, 2000, 82(2): 361-367.
[11] Kim JY, Yu JH, Sung LH, et al. Usefulness of the prostate health index in predicting the presence and aggressiveness of prostate cancer among Korean men: a prospective observational study[J]. BMC Urol, 2021, 21(1): 131.
[12] Tan LG, Tan YK, Tai BC, et al. Prospective validation of p2PSA% and the Prostate Health Index, in prostate cancer detection in initial prostate biopsies of Asian men, with total PSA 4-10 ng mL-1[J]. Asian J Androl, 2017, 19(3): 286-290.
[13] Russo GI, Regis F, Castelli T, et al. A systematic review and meta-analysis of the diagnostic accuracy of prostate health index and 4-kallikrein panel score in predicting overall and high-grade prostate cancer[J]. Clin Genitourin Cancer, 2017, 15(4): 429-439. e1.
[14] Othman H, Abu Yamin AH, Isa NM, et al. Diagnostic performance of prostate health index (PHI) in predicting prostate cancer on prostate biopsy[J]. Malays J Pathol, 2020, 42(2): 209-214.
[15] Anyango R, Ojwando J, Mwita C, et al. Diagnostic accuracy of[-2] proPSA versus Gleason score and Prostate Health Index versus Gleason score for the determination of aggressive prostate cancer: a systematic review[J]. JBI Evid Synth, 2021, 19(6): 1263-1291.
[16] Mottet N, Van Den Bergh RCN, Briers E, et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer-2020 update. part 1:screening, diagnosis, and local treatment with curative intent[J]. Eur Urol, 2021, 79(2): 243-262.
[17] Chiu PK, Ng CF, Semjonow A, et al. A multicentre evaluation of the role of the prostate health index (PHI) in regions with differing prevalence of prostate cancer: adjustment of PHI reference ranges is needed for European and Asian settings[J]. Eur Urol, 2019, 75(4): 558-561.
[18] Choi J, Kang MY, Sung HH, et al. Correlation between Gleason score distribution and Prostate Health Index in patients with prostate-specific antigen values of 2.5-10 ng/mL[J]. Investig Clin Urol, 2020, 61(6): 582-587.
[19] Park H, Lee SW, Song G, et al. Preoperative prostate health index and p2PSA% as the significant biomarkers of postoperative pathological outcomes of prostate cancer in Korean males: a prospective multi-institutional study[J]. Investig Clin Urol, 2020, 61(1): 42-50.
[20] Novak V, Vesely S, Luksanová H, et al. Preoperative prostate health index predicts adverse pathology and Gleason score upgrading after radical prostatectomy for prostate cancer[J]. BMC Urol, 2020, 20(1): 144.
[21] Nassir AM, Kamel HFM. Explication of the roles of prostate health index (PHI) and urokinase plasminogen activator (uPA) as diagnostic and predictor tools for prostate cancer in equivocal PSA range of 4-10 ng/mL[J]. Saudi J Biol Sci, 2020, 27(8): 1975-1984.
[22] Maxeiner A, Kilic E, Matalon J, et al. The prostate health index PHI predicts oncological outcome and biochemical recurrence after radical prostatectomy - analysis in 437 patients[J]. Oncotarget, 2017, 8(45): 79279-79288.
[23] Huang D, Yang XQ, Wu YS, et al. Cost-effectiveness analysis of prostate health index in decision making for initial prostate biopsy[J]. Front Oncol, 2020, 10: 565382.
[24] Niu XK, Li J, Das SK, et al. Developing a nomogram based on multiparametric magnetic resonance imaging for forecasting high-grade prostate cancer to reduce unnecessary biopsies within the prostate-specific antigen gray zone[J]. BMC Med Imaging, 2017, 17(1): 11.
[25] Zhao Y, Simpson BS, Morka N, et al. Comparison of multiparametric magnetic resonance imaging with prostate-specific membrane antigen positron-emission tomography imaging in primary prostate cancer diagnosis: a systematic review and meta-analysis[J]. Cancers, 2022, 14(14): 3497.
[26] Evangelista L, Zattoni F, Cassarino G, et al. PET/MRI in prostate cancer: a systematic review and meta-analysis[J]. Eur J Nucl Med Mol Imaging, 2021, 48(3): 859-873.
[27] Chen Y, Xu D, Ruan M, et al. A prospective study of the prostate health index density and multiparametric magnetic resonance imaging in diagnosing clinically significant prostate cancer[J]. Investig Clin Urol, 2023, 64(4): 363-372.
