Prostate health index reference value

<2ng/ml indicates a very low risk of prostate cancer, 2~10ng/ml is a risk gray area that needs to be comprehensively judged in conjunction with other examinations, and ≥10ng/ml indicates a high risk of prostate cancer, and further puncture biopsy is recommended for confirmation.

I just met a 47-year-old programmer uncle in the clinic last week. He works at his desk for 12 hours every day. The total PSA in the physical examination was 4.2ng/ml, which is just above the well-known PSA threshold. His face turned pale when he took the report. He said that he had browsed Baidu for half a night and had already assumed that he had prostate cancer. He even started to think about his future affairs. I asked him to recheck his PHI, and the result came out to be 1.8. I told him to go to work on the spot, and he would just need to recheck in half a year, so there was no need to speculate.

It's interesting to say that this reference value is not a globally unified standard, and clinical guidelines from different schools have really different statements. For example, in the guidelines updated by the European Society of Urology in the past two years, the PHI cutoff value for men under 50 years old was specifically adjusted to 2.5ng/ml. The reason is very practical: the prostate volume of young men is inherently small, and the basic values ​​of PSA and PHI are normally lower. If it is slightly higher, you must be more vigilant to avoid missing the diagnosis of early-onset prostate cancer. ； However, many grassroots clinicians in China prefer to stick to the 2ng/ml threshold. After all, the penetration rate of prostate cancer screening in our country is not high. A slightly stricter standard can avoid missing some high-risk cases. Both statements are supported by clinical data. There is nothing right or wrong. They are both flexibly adjusted during actual consultations.

Last year, I treated a 68-year-old man who had a history of prostatic hyperplasia for more than 20 years and suffered from prostatitis from time to time. The PHI that time he checked happened to be 9.7, which was 0.3 shy of the critical line of 10. He forced me to be hospitalized directly for puncture. I first performed a digital anal examination on him and found that the prostate was very smooth with no nodules. I also ordered a multi-parameter magnetic resonance imaging and saw no abnormal signals. I made him take anti-inflammatory drugs for two weeks and told him not to ride a bicycle or eat spicy food. A month later, the PHI was rechecked and it dropped directly to 6.2. After nearly two years of follow-up, the value has been stable between 5 and 7, and there are no problems. Later, when he came back for a follow-up examination, he told me that he had been so frightened at home for half a month that he even stopped drinking. If he had known better, he would have seen a doctor first, and he would have suffered so much.

Why are PHI checks increasingly recommended in clinical practice? To put it bluntly, when PSA was checked separately before, nearly 70% of people's PSA would fall in the gray area of ​​4~10ng/ml. It was difficult to judge whether to get a puncture or not. Many people suffered from puncture in vain, and the final result was benign hyperplasia. Now that there is a reference value for PHI, the positive rate of puncture for patients in the gray area with PHI <2 is less than 1%, so they can basically avoid puncture and avoid many sins.

Oh, by the way, there are a few things to note when checking PHI. You don’t need to fast, but it’s best not to have sex, ride a bicycle for a long time, do a digital anal examination, and don’t eat spicy food to stimulate the prostate 3 days before the test. Otherwise, the value will rise, which will only increase your worries. And those friends who have a family history of prostate cancer, don’t get stuck on the reference value. Even if your PHI is only 1.7, I will recommend you to recheck every 3 months. After all, the risk of people with a family history is several times that of ordinary people. It is always right to be cautious.

After all, these reference values ​​are always a tool for doctors to make judgments, not standard answers for patients to scare themselves. If you are really unsure about the report, find a reliable urologist for evaluation, which is much more useful than looking at the online comparison table for a long time.