Why is the prostate health index high?

The core hint of an elevated prostate health index (often referred to as phi in clinical practice) is an increased risk of prostate cancer, but it must not be directly equated with "getting prostate cancer". Inflammation, hyperplasia, and even daily squeezing of the prostate may cause the value to temporarily increase.

Last month, I just received a 52-year-old Chen from the outpatient department. The total PSA in the unit physical examination was 4.6ng/ml, which is just at the critical value. After further testing, the phi went straight to 62. When I got the report, his legs were weak and he said that he didn't have a few years to live. When I asked about it, I found out that he had just cycled around the West Lake for two and a half hours with a cycling team the day before the physical examination. Recently, he had been urinating frequently and urgently. A routine urine test showed that he had bacterial prostatitis. He was first prescribed antibiotics and lifestyle guidance for two weeks, and was prohibited from sitting for long periods of time while riding. During the re-examination, his phi dropped directly to 21, which was completely a false alarm.

Why are everyone so sensitive to increases in this indicator? To put it bluntly, phi itself is promoted to make up for the lack of accuracy of ordinary PSA screening. It integrates and calculates the three indicators of total PSA, free PSA and [-2]proPSA. It can predict prostate cancer by about 30% more accurately than PSA alone. Currently, The commonly used clinical critical value is 27. If it exceeds 27, it will indicate a risk. The higher the value, the higher the probability of detecting prostate cancer by subsequent biopsy. For example, among people with a phi exceeding 60, almost one clinically significant prostate cancer can be detected in every two people who undergo a biopsy. The risk is indeed not low.

However, there are actually different clinical tendencies in the treatment of elevated phi. Some doctors are more cautious. As long as it exceeds the reference value and is accompanied by abnormal PSA, they directly recommend a needle biopsy to clarify the nature. After all, early screening and early treatment are the most effective ways to deal with prostate cancer.； Many doctors will be more conservative, especially for young patients with no family history of prostate cancer and no suspicious nodules on prostate MRI. They will suggest that there are no other interfering factors first. After all, puncture is an invasive operation, so there is no need to suffer in vain.

In addition to cancer, there are actually many factors that can increase phi, such as long-distance cycling, just having a digital rectal examination, ejaculation one or two days before the examination, or suffering from prostatitis or severe prostatic hyperplasia, which may temporarily increase phi. I once met a 38-year-old young man who just participated in a 100-kilometer cycling event the day before the physical examination. His phi went directly to 42. After three weeks of rest at home, it was completely normal and there was no problem.

In fact, to put it bluntly, this indicator is similar to measuring body temperature. A high value will definitely indicate an abnormality in the body. But whether it is a common cold inflammation or a more serious problem must be judged in conjunction with other conditions. You can't just treat it as a serious condition as soon as the fever reaches 38 degrees, right? Don’t panic if your phi is found to be high. First, ask a urology doctor to review your recent lifestyle habits and whether you have any related symptoms. Then do a prostate MRI to see if there are any abnormal nodules. If you suspect there are interfering factors, check the numerical changes again after two or three weeks, and then decide whether to puncture. Don’t frighten yourself by searching blindly. In clinical practice, many people really have false alarms.