Initial Prostate Health Index (phi) and phi density predicts future risk of clinically significant prostate cancer in men with initial negative prostate biopsy: a 6-year follow-up study

Liu, Qinyang; Remmers, Sebastiaan; Lau, Sui-Yan; Yip, S. K. H.; Leung, S. F.; Mak, Christy Wing‐Hin; Yee, Chi‐Hang; Teoh, Jeremy Yuen‐Chun; Hou, See‐Ming; Roobol, Monique J.; Ng, Chi‐Fai; Chiu, Peter Ka‐Fung

doi:10.1038/s41391-021-00444-y

Cited by 8 publications

(5 citation statements)

References 16 publications

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“…Garrido et al proposed PHID ≥ 0.49 as cutoff for csPCa, sparing 26.3% biopsies at 90% sensitivity (53). Besides, in men with initial negative prostate biopsy, those with initial PHID≥ 1.2 may have 21% risk developing csPCa at 6-year follow up, while those with PHID <0.4 had lowest risk and may not need intensive follow-up, depicted in a recent study by Liu et al (56). In our study, at 90% sensitivity, PHID had the highest specificity (54.1%) for csPCa and could reduce the most unnecessary biopsies (43.7%) and miss the least csPCa (8.5%) when PHID > 0.67 (Table 3).…”

Section: Discussionmentioning

confidence: 99%

Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection

Chiu

Cheng

et al. 2021

Front. Oncol.

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BackgroundProstate-specific antigen (PSA) is considered neither sensitive nor specific for prostate cancer (PCa). We aimed to compare total PSA (tPSA), percentage of free PSA (%fPSA), the PSA density (PSAD), Prostate Health Index (PHI), and the PHI density (PHID) to see which one could best predict clinically significant prostate cancer (csPCa): a potentially lethal disease.MethodsA total of 412 men with PSA of 2–20 ng/mL were prospectively included. Serum biomarkers for PCa was collected before transrectal ultrasound guided prostate biopsy. PHI was calculated by the formula: (p2PSA/fPSA) x √tPSA. PHID was calculated as PHI divided by prostate volume measured by transrectal ultrasound.ResultsOf the 412 men, 134 (32.5%) and 94(22.8%) were diagnosed with PCa and csPCa, respectively. We used the area under the receiver operating characteristic curve (AUC) and decision curve analyses (DCA) to compare the performance of PSA related parameters, PHI and PHID in diagnosing csPCa. AUC for tPSA, %fPSA, %p2PSA, PSAD, PHI and PHID were 0.56、0.63、0.76、0.74、0.77 and 0.82 respectively for csPCa detection. In the univariate analysis, the prostate volume, tPSA, %fPSA, %p2PSA, PHI, PSAD, and PHID were all significantly associated with csPCa, and PHID was the most important predictor (OR 1.41, 95% CI 1.15–1.72). Besides, The AUC of PHID was significantly larger than PHI in csPCa diagnosis (p=0.004). At 90% sensitivity, PHID had the highest specificity (54.1%) for csPCa and could reduce the most unnecessary biopsies (43.7%) and miss the fewest csPCa (8.5%) when PHID ≥ 0.67. In addition to AUC, DCA re-confirmed the clinical benefit of PHID over all PSA-related parameters and PHI in csPCa diagnosis. The PHID cut-off value was positively correlated with the csPCa ratio in the PHID risk table, which is useful for evaluating csPCa risk in a clinical setting.ConclusionThe PHID is an excellent predictor of csPCa. The PHID risk table may be used in standard clinical practice to pre-select men at the highest risk of harboring csPCa.

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Section: Discussionmentioning

confidence: 99%

Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection

Chiu

Cheng

et al. 2021

Front. Oncol.

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“…While PHI density improves upon PSA density and PHI alone, these improvements appear modest, which may be why PHI density is rarely incorporated into clinical practice. Several other liquid biomarkers specifically developed for the diagnosis of grade group 2 or higher prostate cancer are also commercially available (eg, 4Kscore, ExoDx, and SelectMDx); indeed, the 4Kscore combined with MRI has shown similar results to those in the study presented here, 3,4 but these biomarkers have not been compared head to head. Prospective studies are needed to define their role in limiting overdiagnosis and avoiding unnecessary prostate biopsies, and to provide patients with accurate personalized risk estimates.…”

Section: Editorial Commentmentioning

confidence: 61%

“…In a recently published paper by Liu et al, prebiopsy PHI or PHI density predicted 6-year risk of csPCa in men with initial negative prostate biopsy. 3 At 6 years of follow-up, csPCa was diagnosed in 0% and 21.0% of men with PHI density of <0.4 and !1.2, respectively. Therefore, PHI and PHI density can provide a guide to how frequently a patient should be followed.…”

Section: Reply By Authorsmentioning

confidence: 98%

Editorial Comment

Calle¹,

Pavlovich²

2023

Journal of Urology

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“…The PHI consistently outperformed the total PSA and percentage of free PSA in terms of accurate PCa detection, especially in men with PSA levels between 2 µg/L and 10 µg/L. Additionally, a 6-year follow-up study indicated that the initial PHI levels could predict the 6-year risk of PCa, with a higher PHI (>35) indicating a greater risk that would prompt closer monitoring [24]. Furthermore, combining the PHI with other diagnostic methods, such as multiparametric magnetic resonance imaging (mpMRI), improved its performance.…”

Section: The Prostate Health Index (Phi)mentioning

confidence: 87%

Biomarkers for Prostate Cancer: From Diagnosis to Treatment

Chen,

Wang,

Liu

et al. 2023

Diagnostics

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Prostate cancer (PCa) is a widespread malignancy with global significance, which substantially affects cancer-related mortality. Its spectrum varies widely, from slow-progressing cases to aggressive or even lethal forms. Effective patient stratification into risk groups is crucial to therapeutic decisions and clinical trials. This review examines a wide range of diagnostic and prognostic biomarkers, several of which are integrated into clinical guidelines, such as the PHI, the 4K score, PCA3, Decipher, and Prolaris. It also explores the emergence of novel biomarkers supported by robust preclinical evidence, including urinary miRNAs and isoprostanes. Genetic alterations frequently identified in PCa, including BRCA1/BRCA2, ETS gene fusions, and AR changes, are also discussed, offering insights into risk assessment and precision treatment strategies. By evaluating the latest developments and applications of PCa biomarkers, this review contributes to an enhanced understanding of their role in disease management.

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Initial Prostate Health Index (phi) and phi density predicts future risk of clinically significant prostate cancer in men with initial negative prostate biopsy: a 6-year follow-up study

Cited by 8 publications

References 16 publications

Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection

Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection

Editorial Comment

Biomarkers for Prostate Cancer: From Diagnosis to Treatment

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