Prostate health index (PHI) and prostate-specific antigen (PSA) predictive models for prostate cancer in the Chinese population and the role of digital rectal examination-estimated prostate volume

Chiu, Peter Ka Fung; Roobol, Monique J.; Teoh, Jeremy Yuen‐Chun; Lee, Wai-Man; Yip, S. K. H.; Hou, See‐Ming; Bangma, Chris H.; Ng, Chi‐Fai

doi:10.1007/s11255-016-1350-8

Cited by 27 publications

(32 citation statements)

References 19 publications

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“…They could help to distinguish PCa from benign prostate tissue, and there was also a tendency to discriminate aggressive (GS

\geq

7) from potentially indolent forms of PCa. The AUC of %p2PSA and PHI were similar to other Asian series [20–23].…”

Section: Discussionsupporting

confidence: 83%

“…In a prospective study of 569 men with PSA levels of 4–10 ng/mL in Hong Kong, Chiu et al. demonstrated that the PHI had better performance over PSA‐based models [22]. In addition, combining the PHI, prostate volume, and age could avoid 38.4% and 55.4% of biopsies at 10% and 20% thresholds of missing PCa, respectively [22].…”

Section: Discussionmentioning

confidence: 99%

“…Its derivatives, %p2PSA and PHI, have been shown to improve the prediction of outcomes of prostate biopsies and define cancer aggressiveness [15–18]. p2PSA and PHI have also been applied in Asian populations in several validation studies [19–23]. However, to the best of our knowledge, no study has investigated p2PSA or PHI in Taiwanese men.…”

Section: Introductionmentioning

confidence: 99%

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Prostate Health Index (PHI) improves prostate cancer detection at initial biopsy in Taiwanese men with PSA 4–10 ng/mL

Hsieh

Chang

Yang

et al. 2018

The Kaohsiung J of Med Scie

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In this study, we aimed to validate the Prostate Health Index (PHI) for the detection of prostate cancer (PCa). We prospectively enrolled patients aged 50-75 years with a serum prostate specific antigen (PSA) level of 4-10 ng/mL undergoing transrectal biopsy of the prostate between April 2016 and May 2017. The primary outcome was the diagnostic performance of various PSA derivatives (total PSA, free PSA, %fPSA, p2PSA, %p2PSA, and PHI) to predict PCa. The secondary outcome was comparisons of PSA derivatives between patients with a Gleason score (GS) ≤6 and GS ≥7. PCa was diagnosed in 36 of 154 (23.4%) patients, and 26 (16.9%) had a GS ≥7. The areas under the receiver operating characteristic curves were significantly greater in %p 2PSA and PHI than in PSA (0.76 vs. 0.57, p = 0.015 and 0.77 vs. 0.57, p = 0.004, respectively). Patients with a GS ≥7PCa had marginally higher %p2PSA and PHI than those with a GS of 6 (17.8 vs. 12.73, p = 0.06; 46.58 vs. 31.55, p = 0.05). At a PHI cutoff value of 29.6, the sensitivity and specificity were 77.8% and 67.8% in detecting PCa, respectively. In addition, 57.1% of the patients avoided an unnecessary biopsy, while three patients (1.9%) with GS 7 PCa were missed. In conclusion, the ability of %p2PSA and PHI to predict prostate biopsy outcome was better than that of PSA and %fPSA in the initial biopsy in Taiwanese men with serum PSA between 4 and 10 ng/mL.

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“…They could help to distinguish PCa from benign prostate tissue, and there was also a tendency to discriminate aggressive (GS

\geq

7) from potentially indolent forms of PCa. The AUC of %p2PSA and PHI were similar to other Asian series [20–23].…”

Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prostate Health Index (PHI) improves prostate cancer detection at initial biopsy in Taiwanese men with PSA 4–10 ng/mL

Hsieh

Chang

Yang

et al. 2018

The Kaohsiung J of Med Scie

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“…[17] More importantly, while PCA3 was more accurate at predicting PCa overall, PHI was the most accurate predictor of significant PCa when compared with PCA3, tPSA, or PSAD, and correlated well with the Gleason Score [16,18,19]. This was true in both European and Chinese populations [18,20]. The addition of age, DRE and/or prostate volume (PV) to the PHI did not increase its predictive power in identifying high-grade PCa in Chinese men.…”

Section: Prostate Health Index (Phi)mentioning

confidence: 88%

Early Diagnosis of Prostate Cancer from the Perspective of Chinese Physicians

Zhou

2020

J. Cancer

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Prostate cancer (PCa) is the seventh most diagnosed cancer and the tenth leading cause of cancer mortality in China. Unlike the USA, both incidence and mortality continue to increase. In China, PCa is often diagnosed at a locally advanced or metastatic stage, resulting in a high mortality-to-incidence ratio. Implementing regular screening using a well-validated biomarker may result in the earlier diagnosis of localized disease. Furthermore, it is important to be able to distinguish between low-grade and high-grade disease, to avoid subjecting patients to unnecessary biopsies, undertreatment of significant disease, or overtreatment of indolent disease. While prostate-specific antigen (PSA) is commonly used in PCa screening around the world, its relationship to PCa is still unclear and results vary widely across different studies. New biomarkers, imaging techniques and risk predictive models have been developed in recent years to improve upon the accurate detection of high-grade PCa. Blood-and urine-based biomarkers, such as PSA isoforms, prostate cancer antigen 3, or mRNA transcripts, have been used to improve the detection of high-grade PCa. These markers have also been used to create risk predictive models, which can further improve PCa detection. Furthermore, multiparametric magnetic resonance imaging is becoming increasingly accessible for the detection of PCa. Because of ethnic variations, biomarkers and risk predictive models validated in Western populations cannot be directly applied to Chinese men. Validation of new biomarkers and risk predictive models in the Chinese population may improve PCa screening and reduce mortality of this disease in China.

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“…good at correctly identifying those without the disease. The SelectMDx test, for example, had the highest sensitivity (0.957, but speci city 0.336)(21,24,33) and PHI had the highest speci city (0.974, but sensitivity 0.129)(18,40). The MRI-targeted biopsy methods generally had a better balance of sensitivity and speci city, ranging from a sensitivity of 0.965 (speci city 0.597) for MRI using a Prostate Imaging-Reporting and Data System (PI-RADS) threshold ≥ 3(22,41) to 0.770 (speci city 0.68) using fusion biopsy…”

mentioning

confidence: 99%

Systematic Review of cost-effectiveness models in prostate cancer: exploring new developments in testing and diagnosis

Keeney

Thom

Turner

et al. 2020

Preprint

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Background There is currently no formal prostate cancer screening programme in the UK. Early detection using age-based prostate-specific antigen (PSA) testing is unlikely to be cost-effective due to limited mortality benefit and harms associated with overdetection. However, the discovery of new prostate cancer specific biomarkers and more accurate diagnostic strategies (e.g. magnetic resonance imaging (MRI)) could improve the outcomes of screening. A systematic review was conducted to assess the evidence base on cost-effectiveness of such innovations and areas for further development. Methods To identify model-based economic evaluations of screening and diagnostic tests for prostate cancer, a systematic review of the literature using the NHS Economic Evaluation Database, Medline, EMBASE, HTA databases, NICE guidelines, and UK National Screening Committee guidance was carried out, between 2009 and 2019. Relevant data were extracted on study type, model inputs, modelling methods and cost-effectiveness conclusions and the results narratively synthesized. Results Sixteen studies were included in the review. Seven studies compared the cost-effectiveness of new urinary or blood biomarkers compared to each other or the PSA test and found the biomarkers e.g. the Prostate Health Index (PHI) and SelectMDx, to be the most cost-effective. Seven studies compared newer prostate biopsy methods, including MRI-guided, to TRUS guided biopsy and found MRI-guided methods to be most cost-effective. The newer detection methods showed a reduction in unnecessary biopsies and overtreatment. However, there was uncertainty around the most cost-effective pathway of follow-up strategies (MRI/biomarkers) in men who have a negative initial biopsy. Many studies did not model stage or grade of cancer, cancer progression or the entire testing, screening and treatment pathway. Very few studies fully accounted for uncertainty in their analysis. Conclusions This review brings together the cost-effectiveness literature for novel screening and testing methods used in the diagnosis of prostate cancer. Several limitations of the published models were identified. The models generally either compared new biomarkers or new imaging techniques which highlights the importance of future work in this area, as biomarkers and imaging are likely to be used in combination.

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Prostate health index (PHI) and prostate-specific antigen (PSA) predictive models for prostate cancer in the Chinese population and the role of digital rectal examination-estimated prostate volume

Abstract: PHI had better performance over PSA-based models and could reduce unnecessary biopsies. A DRE-assessed PV can replace TRUS-assessed PV in multivariate prediction models to facilitate clinical use.

Cited by 27 publications

References 19 publications

Prostate Health Index (PHI) improves prostate cancer detection at initial biopsy in Taiwanese men with PSA 4–10 ng/mL

Prostate Health Index (PHI) improves prostate cancer detection at initial biopsy in Taiwanese men with PSA 4–10 ng/mL

Early Diagnosis of Prostate Cancer from the Perspective of Chinese Physicians

Systematic Review of cost-effectiveness models in prostate cancer: exploring new developments in testing and diagnosis

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