Efficiency evaluation of prostate cancer screening based on prostate-specific antigen and prostate healthy index

doi:10.3969/j.issn.1673-8640.2025.10.004

Abstract

Abstract:

Objective To establish a prostate cancer screening strategy based on prostate-specific antigen（PSA） and prostate healthy index（PHI），and to investigate its diagnostic efficacy. Methods A total of 112 patients with suspected prostate cancer who underwent prostate biopsy at the North Branch of Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine from August 2021 to July 2022 were enrolled. The patients were classified into prostate cancer group（42 cases） and benign disease group（70 cases，benign prostatic hyperplasia） based on the results of prostate biopsy. The clinical data were collected，and PSA，free prostate-specific antigen（f-PSA） and PHI were determined，and the f-PSA/PSA ratio was calculated. Receiver operating characteristic（ROC） curve was used to evaluate the diagnostic efficacy of each indicator for prostate cancer. Results There was statistical significance in age，PSA，f-PSA，PHI，rectal examination abnormal rate and prostate volume between prostate cancer group and benign disease group（P<0.05）. The areas under curves（AUC） for PHI，PSA，f-PSA and the f-PSA/PSA ratio in diagnosing prostate cancer were 0.820，0.771，0.728 and 0.621，respectively. The cut-off value of PSA was 4 ng·mL^-1 when the negative predictive value was the highest（1.000），and the cut-off value of 10 ng·mL^-1 resulted in a positive predictive value of 0.538. The cut-off value of PHI was 55 when the positive predictive value was the highest（0.750）. Based on different cut-off values of PHI，PSA and f-PSA，prostate cancer screening strategies were constructed. The AUC of screening strategy A（PSA 4 ng·mL^-1+ PHI 55），screening strategy B（PSA 4 ng·mL^-1+PHI 27） and screening strategy C（PSA 4，10 ng·mL^-1+f-PSA 1 ng·mL^-1） for diagnosing prostate cancer were 0.710，0.757 and 0.667，respectively. The positive predictive value of screening strategy A was the highest（0.833），and the negative predictive value of screening strategy C was the highest（0.882）. Conclusions PSA combined with PHI and f-PSA can effectively improve the efficacy of prostate cancer screening.

Key words: Prostate-specific antigen, Prostate healthy index, Prostate cancer

CLC Number:

R446.1

SHI Meifang, WU Jiong, HU Jiahua, LIU Tao, CHEN Zhenyan, DAI Jie, HUA Bao, ZOU Zheng. Efficiency evaluation of prostate cancer screening based on prostate-specific antigen and prostate healthy index[J]. Laboratory Medicine, 2025, 40(10): 954-958.

Figures/Tables 6

References 13

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组别	例数	年龄/岁	前列腺癌家族史/[例（%）]	直肠指检异常/[例（%）]	前列腺体积/ cm³
良性疾病组	70	70（65，73）	4（5.71）	14（20.00）	96.53（74.10，116.87）
前列腺癌组	42	75（68，78）	2（4.76）	28（66.67）	66.22（61.15，102.00）
统计值		-1.980	0.023	12.196	2.022
P值		0.048	0.878	<0.001	0.044
组别	PSA/（ng·mL^-1）		f-PSA/（ng·mL^-1）	f-PSA/PSA比值	PHI
良性疾病组	6.92（4.75，11.95）		1.16（0.62，2.05）	0.17±0.07	16.70（9.13，23.99）
前列腺癌组	18.18（9.76，52.89）		2.03（1.25，6.60）	0.15±0.07	52.93（21.00，163.47）
统计值	-3.368		-2.835	1.145	-3.977
P值	<0.001		0.005	0.257	<0.001

组别	例数	年龄/岁	前列腺癌家族史/[例（%）]	直肠指检异常/[例（%）]	前列腺体积/ cm³
良性疾病组	70	70（65，73）	4（5.71）	14（20.00）	96.53（74.10，116.87）
前列腺癌组	42	75（68，78）	2（4.76）	28（66.67）	66.22（61.15，102.00）
统计值		-1.980	0.023	12.196	2.022
P值		0.048	0.878	<0.001	0.044
组别	PSA/（ng·mL^-1）		f-PSA/（ng·mL^-1）	f-PSA/PSA比值	PHI
良性疾病组	6.92（4.75，11.95）		1.16（0.62，2.05）	0.17±0.07	16.70（9.13，23.99）
前列腺癌组	18.18（9.76，52.89）		2.03（1.25，6.60）	0.15±0.07	52.93（21.00，163.47）
统计值	-3.368		-2.835	1.145	-3.977
P值	<0.001		0.005	0.257	<0.001

项目	AUC（95%CI）	临界值	敏感性/%	特异性/%	阳性预期值	阴性预期值
PSA	0.771（0.639~0.872）	2 ng·mL^-1	100.00	2.90	0.382	1.000
		4 ng·mL^-1	100.00	11.40	0.404	1.000
		10 ng·mL^-1	66.70	65.70	0.538	0.767
f-PSA	0.728（0.592~0.838）	1 ng·mL^-1	90.50	45.70	0.500	0.889
f-PSA/PSA比值	0.621（0.482~0.747）	0.25	85.70	8.60	0.360	0.500
PHI	0.820（0.694~0.910）	27	71.43	80.00	0.682	0.824
		36	61.90	80.00	0.650	0.778
		55	47.62	94.29	0.833	0.750

项目	AUC（95%CI）	临界值	敏感性/%	特异性/%	阳性预期值	阴性预期值
PSA	0.771（0.639~0.872）	2 ng·mL^-1	100.00	2.90	0.382	1.000
		4 ng·mL^-1	100.00	11.40	0.404	1.000
		10 ng·mL^-1	66.70	65.70	0.538	0.767
f-PSA	0.728（0.592~0.838）	1 ng·mL^-1	90.50	45.70	0.500	0.889
f-PSA/PSA比值	0.621（0.482~0.747）	0.25	85.70	8.60	0.360	0.500
PHI	0.820（0.694~0.910）	27	71.43	80.00	0.682	0.824
		36	61.90	80.00	0.650	0.778
		55	47.62	94.29	0.833	0.750

项目	AUC（95%CI^①）	临界值组合	敏感性/%	特异性/%	阳性预期值	阴性预期值
筛查策略A	0.710（0.588~0.817）	PSA 4 ng·mL^-1+PHI 55	47.6	94.3	0.833	0.750
筛查策略B	0.757（0.598~0.843）	PSA 4 ng·mL^-1+PHI 27	71.4	80.0	0.682	0.824
筛查策略C	0.667（0.548~0.803）	PSA 4 、10 ng·mL^-1+f-PSA 1 ng·mL^-1	90.5	42.9	0.487	0.882