The application of p2PSA% and prostate health index in prostate cancer detection: A prospective cohort in a Tertiary Medical Center

Cheng, Yung-Ting; Chiang, Chih‐Hung; Pu, Yeong-Shiau; Liu, Shih‐Ping; Lu, Yu-Chuang; Chang, Yi-Kai; Chang, Hong-Chiang; Huang, Kuo-How; Lee, Yuan-Ju; Chow, Po-Ming; Hung, Shih-Chun; Huang, Chao‐Yuan

doi:10.1016/j.jfma.2018.05.001

Cited by 10 publications

(14 citation statements)

References 25 publications

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“…The multivariate logistic regression models for PCa prediction, which include p2PSA and its derivatives, are described in many clinical studies. It was estimated that addition of p2PSA derivatives in a multivariate logistic regression model, which consisted of the most common demographic and clinical PCa predictors, has improved predictive accuracy for overall PCa detection up to 11% and outperformed its independent components [22,23,29,30]. Recently, Loeb et al came to a conclusion that inclusion of phi into the multivariate logistic regression model, which consisted of age, previous biopsy, PV, and tPSA, improved AUC from 0.70 to 0.75 to predict ISUP grade ≥ 2 PCa in males with negative DRE and PSA between 2 and 10 ng/mL [31].…”

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confidence: 99%

Prostate Health Index and Prostate Health Index Density as Diagnostic Tools for Improved Prostate Cancer Detection

Barisiene

Bakavičius

Stanciute

et al. 2020

BioMed Research International

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Background. To evaluate the diagnostic potential of [-2] proPSA (p2PSA), %p2PSA, Prostate Health Index (phi), and phi density (PHID) as independent biomarkers and in composition of multivariable models in predicting high-grade prostatic intraepithelial neoplasia (HGPIN) and overall and clinically significant prostate cancer (PCa). Methods. 210 males scheduled for prostate biopsy with total PSA (tPSA) range 2-10 ng/mL and normal digital rectal examination were enrolled in the prospective study. Blood samples to measure tPSA, free PSA (fPSA), and p2PSA were collected immediately before 12-core prostate biopsy. Clinically significant PCa definition was based on Epstein’s criteria or ISUP grade≥2 at biopsy. Results. PCa has been diagnosed in 112 (53.3%) patients. Epstein significant and ISUP grade≥2 PCa have been identified in 81 (72.3%) and 40 (35.7%) patients, respectively. Isolated HGPIN at biopsy have been identified in 24 (11.4%) patients. Higher p2PSA and its derivative mean values were associated with PCa. At 90% sensitivity, PHID with cut-off value of 0.54 have demonstrated the highest sensitivity of 35.7% for overall PCa detection, so PHID and phi with cut-off values of 33.2 and 0.63 have demonstrated the specificity of 34.7% and 34.1% for ISUP grade≥2 PCa detection at biopsy, respectively. In univariate ROC analysis, PHID with AUC of 0.77 and 0.80 was the most accurate predictor of overall and Epstein significant PCa, respectively, so phi with AUC of 0.77 was the most accurate predictor of ISUP grade≥2 PCa at biopsy. In multivariate logistic regression analysis, phi improved diagnostic accuracy of multivariable models by 5% in predicting ISUP grade≥2 PCa. Conclusions. PHID and phi have shown the greatest specificity at 90% sensitivity in predicting overall and clinically significant PCa and would lead to significantly avoid unnecessary biopsies. PHID is the most accurate predictor of overall and Epstein significant PCa, so phi is the most accurate predictor of ISUP grade≥2 PCa. phi significantly improves the diagnostic accuracy of multivariable models in predicting ISUP grade≥2 PCa.

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confidence: 99%

Prostate Health Index and Prostate Health Index Density as Diagnostic Tools for Improved Prostate Cancer Detection

Barisiene

Bakavičius

Stanciute

et al. 2020

BioMed Research International

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“…Rhodes et al 18 showed that p2PSA derivatives were slightly higher in black men than in white men. Lower PHI values with a higher AUC for cancer detection at the initial TRUSP biopsy were observed in an Asian series compared with European studies 10,19 . At a cut-off range of the PHI between 35 and 55, Asian men had a lower detection rate of PCa and high-grade PCa than European men.…”

Section: Discussionmentioning

confidence: 60%

“…tPSA, ng/ml (IQR) 10.9 (7.5, 16.6) fPSA, ng/ml (IQR) 1 As shown in (Figs. 1 and 2), the %p2PSA and PHI were significantly higher in patients with ≥pT3 disease, high-risk disease, positive surgical margin, and presence of SVI (%p2PSA: p = 0.007, 0.023, 0.005, and 0.033, respectively; PHI: p < 0.001, <0.001, <0.001, and 0.004, respectively).…”

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confidence: 64%

Preoperative %p2PSA and Prostate Health Index Predict Pathological Outcomes in Patients with Prostate Cancer Undergoing Radical Prostatectomy

Cheng

Huang

Chen

et al. 2020

Sci Rep

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To evaluate the predictive accuracy of the %p2PSA and prostate health index (PHI) in predicting aggressive pathological outcomes in patients with prostate cancer (PCa) undergoing radical prostatectomy (RP), we enrolled 91 patients with organ-confined PCa who were treated with robotassisted RP. p2PSA levels and the PHI were investigated for their ability to predict pathological results. The %p2PSA and PHI were both significantly higher in patients with ≥pT3 disease, high-risk disease, positive surgical margin, or seminal vesical invasion (SVI). In univariable analysis, p2PSA derivatives were significant predictors of the presence of ≥pT3 disease, high-risk disease, positive surgical margin, and SVI. To predict adverse pathological outcomes at a sensitivity of 90%, p2PSA derivatives had higher specificity than standard PSA derivatives. In multivariable analysis, additional increases in the area under the receiver operating characteristic curve (AUC) were observed with the %p2PSA and PHI for ≥pT3 disease, high-risk disease, and positive surgical margin (8.2% and 2.7%, 6.2% and 4.1%, and 8.6% and 5.4%, respectively). A PHI ≥61.26 enhanced the predictive accuracy of the model for SVI by increasing the AUC from 0.624 to 0.819 (p = 0.009). The preoperative %p2PSA and PHI accurately predict adverse pathological results and are useful for decision-making.In patients with prostate cancer (PCa), it is vital to avoid overtreatment and procedural complications. Treatment options for localized PCa including active surveillance, radical prostatectomy (RP), and radiation therapy depend on the aggressiveness of the disease 1 . However, discrepancies often exist between the clinical cancer staging and pathological staging. Approximately half of patients with clinically low-risk PCa at transrectal ultrasonography-guided biopsy of the prostate (TRUSP biopsy) actually have a Gleason score (GS) ≥7 or ≥pathological T3 disease in the final RP pathology 2,3 .Multiple preoperative predictive nomograms have been validated for the prediction of pathological outcomes at RP. However, the applicability of these nomograms is limited in the clinical setting due to their difficult accessibility and complexity 4 . Therefore, magnetic resonance imaging (MRI) has been increasingly used as an alternative diagnostic tool before prostate biopsy or via MRI-targeted biopsy to better identify clinically significant cancer with a GS ≥7 5 . Correct assessment of the local staging by MRI is still being researched. However, the utility of MRI in local cancer staging is limited by its poor sensitivity for detecting extracapsular extension and seminal vesical invasion (SVI) 6 . Accordingly, we need an accurate and convenient biomarker for preoperatively predicting www.nature.com/scientificreports www.nature.com/scientificreports/ adverse pathological characteristics and determining who might benefit the most from surgery. Such a biomarker would help physicians in decision-making and to predict prognosis before any intervention.Total prostate-specific antigen (t...

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“…They reported that AUC was 0.793; sensitivity was 90% and specificity was 58.27% at cut off value of 26.75 ( Tan et al, 2017 ). Recently, in another prospective study among 121 Taiwanese males with tPSA levels between 4.3 and 7.6 ng/ml, PHI showed AUC of 0.772; at 90% sensitivity, specificity was 27.27% at cut off 21.62 ( Cheng et al, 2019 ). The range of AUC from three previous meta-analysis studies was 0.69–0.781 ( Bruzzese et al, 2014 ; X.…”

Section: Discussionmentioning

confidence: 99%

“…Both of PHI (p ≤ 0.001) and uPA (p = 0.020) were independent predictors of Gleason score, while only PHI (p = 0.004) was an independent predictor of LN involvement. Several retrospective studies investigated the potential role of PHI for prediction of PCa ( Cheng et al, 2019 , Lazzeri et al, 2013a , Stephan et al, 2013 ), advanced pathological features, aggressiveness of PCa ( Chiu et al, 2016 , Fossati et al, 2015a ), or pathological reclassification after one year at active surveillance ( Hirama et al, 2014 , Tosoian et al, 2012 ). Of annotation, PHI was reported to be the most precise independent predictor for pathologic Gleason score ≥ 7 and pathologic stage T3 in patients who underwent radical prostatectomy ( Nicola Fossati et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Explication of the roles of prostate health index (PHI) and urokinase plasminogen activator (uPA) as diagnostic and predictor tools for prostate cancer in equivocal PSA range of 4–10 ng/mL

Nassir

Kamel

2020

Saudi Journal of Biological Sciences

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Background Prostate cancer (PCa) is one of the most commonly encountered cancers and the leading cause of death worldwide. Currently used biomarkers accounts difficulties in discriminating benign from malignant cases or predicting outcome, so investigating new biomarkers performance is needed. Objectives Assessment of diagnostic and predictor roles of prostate health index (PHI) and urokinase plasminogen activator (uPA) in PCa. Methods 194 males with initial tPSA of 4–10 ng/mL were categorized into three groups: PCa, benign prostatic hyperplasia (BPH) and healthy control. Serum levels of tPSA, fPSA, p2PSA, and uPA were performed by ELISA with calculation of PHI as (p2PSA/fPSA) × √PSA. Results PHI and uPA were significantly higher in PCa patients relevant to BPH and healthy control (p ≤ 0.001). Both markers outperformed all assessed biomarkers and showed the highest area under the curve (AUC) in ROC curve analysis. Both were significantly higher in PCa patients with {Gleason score ≥ 7, late stages (cT2b,c; T3), LN extension and distant metastasis}relative to their counterparts. Additionally, PHI and uPA and were independent predictors of distant metastasis and Gleason score ≥ 7, while PHI was predictor of LN invasion (β = 0.25, p = 0.004). Conclusion PHI and uPA would be of potential value in discriminating between PCa, BPH and healthy men in addition, both are promising as independent predictors of adverse pathological features.

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The application of p2PSA% and prostate health index in prostate cancer detection: A prospective cohort in a Tertiary Medical Center

Abstract: %p2PSA and PHI increased the diagnostic accuracy with significantly greater sensitivity and specificity than tPSA. We determined an optimal cut-off value of PHI among Taiwanese population. These findings support the usefulness in the decisional process of prostate biopsy.

Cited by 10 publications

References 25 publications

Prostate Health Index and Prostate Health Index Density as Diagnostic Tools for Improved Prostate Cancer Detection

Prostate Health Index and Prostate Health Index Density as Diagnostic Tools for Improved Prostate Cancer Detection

Preoperative %p2PSA and Prostate Health Index Predict Pathological Outcomes in Patients with Prostate Cancer Undergoing Radical Prostatectomy

Explication of the roles of prostate health index (PHI) and urokinase plasminogen activator (uPA) as diagnostic and predictor tools for prostate cancer in equivocal PSA range of 4–10 ng/mL

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