Abstract

Background: prostatic specific antigen (Free and total PSA) has been used world- wide for the detection of prostatic carcinoma however it has low specificity especially in PSA range between 4-10 ng/ml, this low specificity leads to unnecessary prostatic biopsy. Prostatic health index (PHI) is a new FDA approved test used to accurately correlate the relationship between prostatic carcinoma and high total PSA of 4-10 ng/ml. Objective: we assessed the diagnostic performance of -2proPSA and PHI for the finding of prostatic carcinoma in men with total PSA range of 4-10 ng/ml. Patients and methods: Fifty candidates with PSA between 4-10 ng/ml subjected to blood test for estimation of -2proPSA, free PSA and Subsequently subjected to prostatic biopsy at Azadi teaching hospital/Duhok, during the period of (August 2018 to August 2019) for correlation and prostatic cancer detection using this formula:(-2proPSA/free PSA) x square root (PSA). Results: fifty patients with range between 50-80 years presented with lower urinary tract symptoms with total PSA of 4-10 ng/ml underwent prostatic biopsy, the mean scores for positive and negative prostatic carcinoma were as follow respectively (median values total PSA: 7 versus 6 ng/ml, -2proPSA: 15 versus 11.5 ng/ml , PHI: 59 versus 33) setting the sensitivity of 90%, PHI had greater specificity for detecting prostatic carcinoma in comparison to free PSA % and total PSA. Area under the curve for PHI and -2proPSA were AUC (0.76 and 0.732) respectively compared to other markers. Conclusion: In group with PSA between 4-10 ng/ml and normal digital rectal examination, the PHI raised the specificity for the detection of prostatic carcinoma which leads to decrease in number of unnecessary prostatic biopsy. Keywords: Prostatic health index PHI, Prostate cancer PCa,-2proPSA, free PSA, Area under curve AUC