Performance of prostate health index and PSA density in a diverse biopsy‐naïve cohort with mpMRI for detecting significant prostate cancer

Carbunaru, Samuel; Stinson, James; Babajide, Rilwan; Hollowell, Courtney M.P.; Yang, Ximing J.; Sekosan, Marin; Ferrer, Karen; Kajdacsy-Balla, André; Abelleira, Josephine; Ruden, Maria; King-Lee, Patrice; Dalton, Daniel P.; Casalino, David D.; Kittles, Rick A.; Gann, Peter H.; Schaeffer, Edward M.

doi:10.1002/bco2.91

Cited by 9 publications

(6 citation statements)

References 26 publications

(44 reference statements)

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“…Following mpMRI, most of the patients in our study group had PIRADS 4 and 5 score lesions (74%) while only 26% had PIRADS 3 lesions which is similar to other reports [ 20 , 21 , 22 ]. However, in contrast to other studies, we found no significant correlation between the PIRADS score and PSA values.…”

Section: Discussionsupporting

confidence: 91%

Transperineal Prostate Biopsy Targeted by Magnetic Resonance Imaging Cognitive Fusion

et al. 2023

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Prostate cancer is among the most frequently diagnosed cancers and a leading cause of cancer-related death in men. Currently, the most reliable and widely used imaging test for prostate cancer diagnosis is multiparametric pelvic magnetic resonance imaging (mpMRI). Modern biopsy techniques are based on the computerised merging of ultrasound and MRI images to provide better vision during the biopsy procedure (Fusion Biopsy). However, the method is expensive due to high equipment cost. Cognitive fusion of ultrasound and MRI images has recently emerged as a cheaper and easier alternative to computerised fusion. The aim of this prospective study is to perform an in-patient comparison of the systematic prostate biopsy procedure (SB) vs. cognitive fusion (CF) guided prostate biopsy method in terms of safety, ease of use, cancer detection rate and clinically significant cancer detection. We enrolled 103 patients with suspected prostate cancer that were biopsy naive, with PSA > 4 ng/dL and PIRADS score of 3, 4 or 5. All patients received a transperineal standard 12–18 cores systematic biopsy (SB) and a four-cores targeted cognitive fusion (CF) biopsy. Following the prostate biopsy, 68% of the patients were diagnosed with prostate cancer (70/103 patients). SB diagnosis rate was 62% while CF biopsy was slightly better with a 66% rate. There was a significant 20% increase in clinically significant prostate cancer detection rate for the CF compared to SB (p < 0.05) and a significant prostate cancer risk upgrade from the low to the intermediate risk category (13%, p = 0.041). Transperineal cognitive fusion targeted prostate biopsy is a straightforward biopsy method that is easy to perform and is a safe alternative to standard systematic biopsy with improved significant cancer detection accuracy. A combined targeted and systematic approach should be used for the best diagnostic results.

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Section: Discussionsupporting

confidence: 91%

Transperineal Prostate Biopsy Targeted by Magnetic Resonance Imaging Cognitive Fusion

et al. 2023

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“…At a 90% sensitivity, the PHI's specificity was 58.3%, potentially avoiding 77 cases (49%) of unnecessary biopsy 22 . The usefulness of PHI has been confirmed by several studies conducted in various ethnic groups and regions 23–25 . It is essential to determine population‐specific reference ranges and cutoff values for the PHI to optimize its diagnostic utility in different ethnic groups and regions.…”

Section: Discussionmentioning

confidence: 97%

“…22 The usefulness of PHI has been confirmed by several studies conducted in various ethnic groups and regions. [23][24][25] It is essential to determine population-specific reference ranges and cutoff values for the PHI to optimize its diagnostic utility in different ethnic groups and regions. A multicenter study involving nine clinical sites in Europe and Asia demonstrated that in Asian populations, implementing a threshold of PHI > 30 could potentially avoid 56% of biopsies and 33% of Gleason 6 PCa diagnoses.…”

Section: Discussionmentioning

confidence: 99%

Based on PI‐RADS v2.1 combining PHI and ADC values to guide prostate biopsy in patients with PSA 4−20 ng/mL

Huang,

Liu,

et al. 2023

The Prostate

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PurposeThe study aimed to investigate the diagnostic accuracy of prostate health index (PHI) and apparent diffusion coefficient (ADC) values in predicting prostate cancer (PCa) and construct a nomogram for the prediction of PCa and clinically significant PCa (CSPCa) in Prostate Imaging‐Reporting and Data System (PI‐RADS) three lesions cohort.MethodsThis study prospectively enrolled 301 patients who underwent multiparametric magnetic resonance (mpMRI) and were scheduled for prostate biopsy. The receiver operating characteristic curve (ROC) was performed to estimate the diagnostic accuracy of each predictor. Univariable and multivariable logistic regression analysis was conducted to ascertain hidden risk factors and constructed nomograms in PI‐RADS three lesions cohort.ResultsIn the whole cohort, the area under the ROC curve (AUC) of PHI is relatively high, which is 0.779. As radiographic parameters, the AUC of PI‐RADS and ADC values was 0.702 and 0.756, respectively. The utilization of PHI and ADC values either individually or in combination significantly improved the diagnostic accuracy of the basic model. In PI‐RADS three lesions cohort, the AUC for PCa was 0.817 in the training cohort and 0.904 in the validation cohort. The AUC for CSPCa was 0.856 in the training cohort and 0.871 in the validation cohort. When applying the nomogram for predicting PCa, 50.0% of biopsies could be saved, supplemented by 6.9% of CSPCa being missed.ConclusionPHI and ADC values can be used as predictors of CSPCa. The nomogram included PHI, ADC values and other clinical predictors demonstrated an enhanced capability in detecting PCa and CSPCa within PI‐RADS three lesions cohort.

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“…The additional benefits of PHI over PSAD in MRI-guided biopsies have been reported in a few studies with sample sizes of around 100 or fewer PI-RADS 3 cases. 9,[16][17][18][19][20] The optimal PHI cutoff and reference ranges specifically for each PI-RADS score could not be defined due to limited sample sizes. PHID has also been shown to perform better than PHI, PSAD, and PSA in csPCa predictions.…”

Section: Discussionmentioning

confidence: 99%

Prostate Health Index Density Outperforms Prostate-specific Antigen Density in the Diagnosis of Clinically Significant Prostate Cancer in Equivocal Magnetic Resonance Imaging of the Prostate: A Multicenter Evaluation

et al. 2023

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Purpose:We compare Prostate Health Index, Prostate Health Index density, and PSA density in predicting clinically significant prostate cancer in MRI-guided prostate biopsy.Materials and Methods:This is a multicenter evaluation of prospectively maintained prostate biopsy databases at 10 urology centers. Men with Prostate Health Index and MRI-guided targeted and systematic prostate biopsy performed and without prior prostate cancer diagnosis were included. The additional value of PSA density, Prostate Health Index, and Prostate Health Index density to MRI PI-RADS (Prostate Imaging Reporting & Data System) score was evaluated with multivariable analyses, area under the curve, and decision curve analyses. The proportion of unnecessary biopsies that can be avoided are estimated for clinically significant prostate cancer (International Society of Urological Pathology group ≥2 prostate cancer).Results:A total of 1,215 men were analyzed. Prostate cancer and clinically significant prostate cancer were diagnosed in 51% (617/1,215) and 35% (422/1,215) of men, respectively. Clinically significant prostate cancer was diagnosed in 4.4% (3/68), 15% (72/470), 39% (176/446), and 74% (171/231) of highest PI-RADS score of 2, 3, 4, and 5 lesions, respectively. In multivariable analyses, independent predictors for clinically significant prostate cancer detection included Prostate Health Index (OR 1.04), prostate volume (OR 0.97), and PI-RADS score 4 (OR 2.81) and 5 (OR 8.34). Area under the curve for clinically significant prostate cancer of PI-RADS + Prostate Health Index density (0.85) was superior to PI-RADS + PSA density (0.81), Prostate Health Index density (0.81), Prostate Health Index (0.78), PI-RADS (0.76), PSA density (0.72), and PSA (0.60) in the whole cohort, and the superiority of Prostate Health Index density was also observed in PI-RADS 3 lesions. Decision curve analysis showed Prostate Health Index density achieving the best net clinical benefit in PI-RADS 3 or 4 cases. Among PI-RADS 3 lesions, using cutoffs of PSA density 0.15, Prostate Health Index 38.0, and Prostate Health Index density 0.83 could reduce 58%, 67%, and 72% of unnecessary biopsies, respectively.Conclusions:Prostate Health Index density outperformed Prostate Health Index or PSA density in clinically significant prostate cancer detection in men with multiparametric MRI performed, and further reduced unnecessary biopsies in PI-RADS 3 lesions.

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Performance of prostate health index and PSA density in a diverse biopsy‐naïve cohort with mpMRI for detecting significant prostate cancer

Cited by 9 publications

References 26 publications

Transperineal Prostate Biopsy Targeted by Magnetic Resonance Imaging Cognitive Fusion

Transperineal Prostate Biopsy Targeted by Magnetic Resonance Imaging Cognitive Fusion

Based on PI‐RADS v2.1 combining PHI and ADC values to guide prostate biopsy in patients with PSA 4−20 ng/mL

Prostate Health Index Density Outperforms Prostate-specific Antigen Density in the Diagnosis of Clinically Significant Prostate Cancer in Equivocal Magnetic Resonance Imaging of the Prostate: A Multicenter Evaluation

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