A Multicentre Evaluation of the Role of the Prostate Health Index (PHI) in Regions with Differing Prevalence of Prostate Cancer: Adjustment of PHI Reference Ranges is Needed for European and Asian Settings

Chiu, Peter Ka‐Fung; Ng, Chi Fai; Semjonow, Axel; Zhu, Yao; Vincendeau, S.; Houlgatte, A.; Lazzeri, Massimo; Guazzoni, Giorgio; Stephan, Carsten; Haese, Alexander; Bruijne, I.; Teoh, Jeremy Yuen‐Chun; Leung, S. F.; Casale, Paolo; Chiang, Chiao–Hsi; Tan, Lincoln; Chiong, Edmund; Huang, Chao Yuan; Wu, Hsi Chin; Nieboer, Daan; Ye, Ding Wei; Bangma, Chris H.; Roobol, Monique J.

doi:10.1016/j.eururo.2018.10.047

Cited by 69 publications

(51 citation statements)

References 9 publications

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“…Clinical significance was defined as Gleason ≥3 + 3 with a PHI > 40. Using this cutoff, 40% of all biopsies could have been prevented as well as the diagnosis of a Gleason 3 + 3 tumor in 31% of the cases [11]. Interestingly, with the same sensitivity, a cutoff value for PHI of 30% was determined in the same study for 1,688 Asian men.…”

Section: Color Version Available Onlinementioning

confidence: 88%

Use of the Prostate Health Index and Density in 3 Outpatient Centers to Avoid Unnecessary Prostate Biopsies

Schulze¹,

Christoph²,

Sachs³

et al. 2020

Urol Int

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Objectives: We investigated the diagnostic efficacy of the prostate health index (PHI) and PHI density (PHID) to avoid unnecessary prostate biopsies in 3 urological practices. Methods: In 122 patients, total prostate-specific antigen (PSA), free PSA (f-PSA), the quotient from total PSA and f-PSA (f-PSA%), and [-2]pro-PSA were measured in the serum; PHI, PHID, and PSA density (PSAD) were calculated prior to prostate biopsy. Tissue sampling via transrectal biopsy was indicated in case of suspicious PSA (progression and/or elevation of PSA) and/or suspicious digital rectal examination. PSAD, PHI, and PHID were not used for biopsy indication. The diagnostic efficacy was determined with receiver-operating characteristic (ROC) and decision curve analyses. Results:Based on prostate biopsies, 38% (n = 46) of the cases had no prostate carcinoma (PCa), 21% (n = 26) no clinically significant (insignificant) PCa, and 41% (n = 50) had clinically significant PCa. ROC analyses of the PSA parameters showed higher diagnostic efficacy for PHI and PHID (AUC 0.722 and 0.739) than for f-PSA%, PSA, and PSAD (AUC 0.612, 0.595, and 0.698, respectively) regarding carcinoma diagnosis. With a combined use of PHI and PHID (cutoff > 40 and > 0.9, respectively), only 1 clinically significant PCa would have been missed (sensitivity 98%); in 24 (20%) patients, biopsy could have been avoided. Conclusion: The integration of PHI and PHID could improve the diagnostic efficacy of risk calculators to avoid unnecessary prostate biopsies. However, as a prerequisite, validation of cutoff values in prospective studies is urgently required.

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Section: Color Version Available Onlinementioning

confidence: 88%

Use of the Prostate Health Index and Density in 3 Outpatient Centers to Avoid Unnecessary Prostate Biopsies

Schulze¹,

Christoph²,

Sachs³

et al. 2020

Urol Int

Self Cite

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“…More recently, a multicentric study [25] including 1652 subjects (503 European and 1149 Asian) showed that using PHI, more biopsies could be avoided in Asian than in European men (56% vs. 40%). This finding was not surprising, taking into account that an Asian man had a PCa risk about four-fold lower than a European man.…”

Section: Active Surveillancementioning

confidence: 99%

Beyond PSA: The Role of Prostate Health Index (phi)

Ferro

Cobelli

Lucarelli

et al. 2020

IJMS

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Background: Widespread use of prostate specific antigen (PSA) in screening procedures allowed early identification of an increasing number of prostate cancers (PCas), mainly including indolent cancer. Availability of different therapeutic strategies which have a very different impact on the patient's quality of life suggested a strong need for tools able to identify clinically significant cancer at diagnosis. Multi-parametric magnetic resonance showed very good performance in pre-biopsy diagnosis. However, it is an expensive tool and requires an experienced radiologist. In this context, a simple blood-based test is worth investigating. In this context, researchers focused their attention on the development of a laboratory test able to minimize overdiagnosis without losing the identification of aggressive tumors. Results: Recent literature data on PCa biomarkers revealed a clear tendency towards the use of panels of biomarkers or a combination of biomarkers and clinical variables. Phi, the 4Kscore, and Stockholm3 as circulating biomarkers and the Mi-prostate score, Exo DX Prostate, and Select MD-X as urinary biomarker-based tests have been developed. In this scenario, phi is worthy of attention as a noninvasive test significantly associated with aggressive PCa. Conclusions: Literature data showed that phi had good diagnostic performance to identify clinically significant (cs) PCa, suggesting that it could be a useful tool for personalized treatment decision-making. In this review, phi potentialities, limitations, and comparisons with other blood-and urinary-based tests were explored.

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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: 61%

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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A Multicentre Evaluation of the Role of the Prostate Health Index (PHI) in Regions with Differing Prevalence of Prostate Cancer: Adjustment of PHI Reference Ranges is Needed for European and Asian Settings

Cited by 69 publications

References 9 publications

Use of the Prostate Health Index and Density in 3 Outpatient Centers to Avoid Unnecessary Prostate Biopsies

Use of the Prostate Health Index and Density in 3 Outpatient Centers to Avoid Unnecessary Prostate Biopsies

Beyond PSA: The Role of Prostate Health Index (phi)

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

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