prostate health index

The Prostate Health Index (PHI) is one of the most accurate non-invasive blood indicators for clinical screening of prostate cancer risk. It is more than 30% more accurate in identifying malignancy than the detection of prostate specific antigen (PSA) alone. Its core function is to help men with PSA in the "grey zone" avoid unnecessary puncture biopsies, reduce excessive medical treatment and reduce the risk of missed diagnosis.

I was particularly impressed by Lao Zhou, who I met during my rotation in the Department of Urology two years ago. He was 52 years old and had been driving a taxi for almost 20 years. The total PSA in the unit physical examination was 5.3ng/ml, which was just stuck in the "gray area" of 4-10ng/ml that is often said in clinical practice. At that time, the doctor at the community hospital directly asked him to go to a large hospital for a puncture. He was so scared that he did not sleep well for two nights in a row. After all, the puncture had to start from the beginning. When inserting a needle into the perineum or rectum, it hurts on the one hand, and on the other hand, he was afraid of penetrating into normal tissue and causing infection. When he came to our department, the director first asked him to check the PHI, and the result was 21, which is lower than the commonly used cutoff value of 27 in China. He was told that he did not need to insert the needle for the time being, and that he would only need to review it every six months. Now, it has been two and a half years, and his indicators have been very stable at every follow-up, and even the symptoms of prostatic hyperplasia have not worsened.

However, don’t think that PHI is a panacea. In fact, the industry has always had different trends in its use boundaries. For example, the NCCN guidelines in Europe and the United States clearly recommend that PHI be checked first after PSA enters the gray zone. As long as the value is lower than the critical value, there is no family history, and there is no obvious urinary abnormality, follow-up observation can be performed without further invasive examination, which can eliminate almost 40% of unnecessary punctures. However, many domestic urological oncology doctors will be more cautious, especially when they encounter patients with a family history of prostate cancer and particularly obvious symptoms of difficulty urinating. Even if the PHI value is normal, they will recommend a multi-parameter MRI scan. I met a 47-year-old patient last year. His father died of prostate cancer when he was 60 years old. The physical examination PSA was 6.1ng/ml, and the PHI was 24, which was 3 points lower than the critical value. However, the MRI scan showed a small peripheral nodule. After puncture, he was diagnosed with low-risk prostate cancer. He underwent radical surgery in time and is recovering very well. To put it bluntly, the indicator is dead, and the person is alive. You cannot make a conclusion based on just a numerical value.

Oh, by the way, many people don’t know when to check this. In fact, you don’t need to treat it as a routine physical examination from the very beginning. After all, it is not cheap. Public hospitals charge about 300-500 yuan. If your physical examination PSA happens to fall in the gray area of ​​4-10ng/ml, don’t rush to the doctor to prescribe a puncture order first. Ask if you can add a PHI test first. ； If you are over 45 years old and have a direct relative in your family who has had prostate cancer, you can take the initiative to mention this item during your annual physical examination. Just draw a tube of blood. There is no need to fast, and there is no additional pain.

As a reminder, it is best not to do a digital rectal examination, ride a bicycle, or have sex 2-3 days before the test, otherwise it will stimulate prostate secretion and the values ​​will be ridiculous. Last month, there was a 39-year-old young man who rode a 30-kilometer road bike to the suburbs with his friends on the weekend. He went directly for a physical examination on Monday. His PSA was 6.7 and his PHI was 36. When he came with the report, his face was pale. I asked him to go home and rest for a week before checking again. All the indicators were normal. It was purely a bicycle accident. It was a false alarm.

In fact, many men are now somewhat polarized about prostate-related examinations. They either think they are all lies and don't take them to heart at all, or they are frightened when they see a higher PSA and want to have their prostate removed immediately. To put it bluntly, the emergence of PHI gives everyone a buffer option. You don’t have to choose between “direct puncture” and “don’t ask”. However, the final judgment must be based on your own physical condition, family history, and the clinical experience of your doctor. After all, there is never a one-size-fits-all standard answer to health matters.