前瞻性评估前列腺健康指数 (PHI) 如何在现实生活中对前列腺特异性抗原 (PSA) 水平在 4 至 10 ng/mL 之间且直肠指检正常的男性的临床决策产生影响。 自 2016 年以来，香港所有公立医院均已向符合条件的男性免费提供 PHI。 2016 年 5 月至 2017 年 8 月期间，所有在香港所有公立泌尿科单位接受 PHI 检测的符合资格的患者（n = 16）均被前瞻性纳入并进行随访。所有纳入的男性均进行了 PHI 测试，并解释了其结果和影响；随后与泌尿科医师共同决策，决定后续的后续计划。对患者进行了为期 2 年的随访，结果包括前列腺活检率和与初始 PHI 测量相关的活检结果分析。总共 2828 名患者进行了 2 年的随访。大多数 (82%) 的 PHI 结果处于较低风险范围（分数 <35）。了解 PHI 结果后，83% PSA 升高的患者决定不进行活检。总的来说，PHI 评分 <35 和 ≥35 组的人分别有 11% 和 45% 选择活检。国际泌尿病理学会（ISUP）分级组（GG）≥2级癌症的初始检出率，PHI评分≥35组（23%）高于PHI评分<35组（7.9%）。在初始活检无阳性结果的患者中，中位随访中，PHI 评分≥35 组 (34%) 的 ISUP GG ≥2 癌症随后活检阳性率高于 PHI 评分 <35 组 (13%) 2.4年。在现实生活中，随着PHI纳入常规临床路径，83%的PSA水平升高的患者决定不接受前列腺活检。与 PSA 驱动的策略相比，PHI 途径还提高了高级别前列腺癌的检出率。较高的基线 PHI 可以预测随后 2 年时的活检结果。 PHI 可以作为个体化活检决策和随访频率的工具。© 2024 作者。 BJU International 约翰·威利 (John Wiley) 出版

To prospectively evaluate how the Prostate Health Index (PHI) impacts on clinical decision in a real-life setting for men with a prostate-specific antigen (PSA) level between 4 and 10 ng/mL and normal digital rectal examination.Since 2016, the PHI has been available at no cost to eligible men in all Hong Kong public hospitals. All eligible patients who received PHI testing in all public Urology units (n = 16) in Hong Kong between May 2016 and August 2017 were prospectively included and followed up. All included men had a PHI test, with its result and implications explained; the subsequent follow-up plan was then decided via shared decision-making with urologists. Patients were followed up for 2 years, with outcomes including prostate biopsy rates and biopsy findings analysed in relation to the initial PHI measurements.A total of 2828 patients were followed up for 2 years. The majority (82%) had PHI results in the lower risk range (score <35). Knowing the PHI findings, 83% of the patients with elevated PSA decided not to undergo biopsy. In all, 11% and 45% opted for biopsy in the PHI score <35 and ≥35 groups, respectively. The initial detection rate of International Society of Urological Pathology (ISUP) Grade Group (GG) ≥2 cancer was higher in the PHI score ≥35 group (23%) than in the PHI score <35 group (7.9%). Amongst patients with no initial positive biopsy findings, the subsequent positive biopsy rate for ISUP GG ≥2 cancer was higher in the PHI score ≥35 group (34%) than the PHI score <35 group (13%) with a median follow-up of 2.4 years.In a real-life setting, with the PHI incorporated into the routine clinical pathway, 83% of the patients with elevated PSA level decided not to undergo prostate biopsy. The PHI pathway also improved the high-grade prostate cancer detection rate when compared to PSA-driven strategies. Higher baseline PHI predicted subsequent biopsy outcome at 2 years. The PHI can serve as a tool to individualise biopsy decisions and frequency of follow-up visits.© 2024 The Author(s). BJU International published by John Wiley & Sons Ltd on behalf of BJU International.