Prostate-specific Antigen Parameters and Prostate Health Index Enhance Prostate Cancer Prediction With the In-bore 3-T Magnetic Resonance Imaging-guided Transrectal Targeted Prostate Biopsy After Negative 12-Core Biopsy

Friedl, Alexander; Stangl, Kathrin; Bauer, W.; Kivaranovic, Danijel; Schneeweiss, J; Susani, Martin; Hruby, Stephan; Lusuardi, Lukas; Lomoschitz, F.; Eisenhuber-Stadler, Edith; Schima, Wolfgang; Brössner, Clemens

doi:10.1016/j.urology.2017.08.019

Cited by 22 publications

(23 citation statements)

References 25 publications

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“…Since then, only 2 more studies on PHID were published [12,13]. In a study in 118 patients in 2017, Tosoian et al [13] determined thus far the highest value for PHID in the ROC analysis with an AUC of 0.84 and a PHID median of 1.21 for clinically significant PCa.…”

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confidence: 99%

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: 99%

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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“…The difference in the area under the receiver operating characteristic (ROC)-curve (AUC) between PHI (0.76) and PHID (0.77) was small and multivariate models only marginally improved AUCs to 0.79 [ 10 ]. Since then, only few PHID studies were published [ 11 , 12 ]. Tosoian et al [ 12 ] calculated the largest AUC for PHID with 0.84 while PHI and %fPSA had 0.76 and 0.75, respectively.…”

Section: Introductionmentioning

confidence: 99%

PHI density prospectively improves prostate cancer detection

et al. 2021

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Purpose To evaluate the Prostate Health Index (PHI) density (PHID) in direct comparison with PHI in a prospective large cohort. Methods PHID values were calculated from prostate-specific antigen (PSA), free PSA and [− 2]proPSA and prostate volume. The 1057 patients included 552 men with prostate cancer (PCa) and 505 with no evidence of malignancy (NEM). In detail, 562 patients were biopsied at the Charité Hospital Berlin and 495 patients at the Sana Hospital Offenbach. All patients received systematic or magnetic resonance imaging (MRI)/ultrasound fusion-guided biopsies. The diagnostic accuracy was evaluated by receiver operating characteristic (ROC) curves comparing areas under the ROC-curves (AUC). The decision curve analysis (DCA) was performed with the MATLAB Neural Network Toolbox. Results PHID provided a significant larger AUC than PHI (0.835 vs. 0.801; p = 0.0013) in our prospective cohort of 1057 men from 2 centers. The DCA had a maximum net benefit of ~ 5% for PHID vs. PHI between 35 and 65% threshold probability. In those 698 men within the WHO-calibrated PSA grey-zone up to 8 ng/ml, PHID was also significantly better than PHI (AUC 0.819 vs. 0.789; p = 0.0219). But PHID was not different from PHI in the detection of significant PCa. Conclusions Based on ROC analysis and DCA, PHID had an advantage in comparison with PHI alone to detect any PCa but PHI and PHID performed equal in detecting significant PCa.

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“…In contrast, for patients with a PSA concentration of less than 20 ng/mL, the tumors are mostly focal, and increased numbers of biopsy sites are conducive to tumor detection. 26 Results of the age grouping showed that there were no statistically significant differences between the 12and 10-core biopsy methods for both the group that was 70 years and older and the group that was younger than 70 years, whereas the 12-core biopsy method differed significantly from any of the other biopsy methods in the PCa and csPCa detection rates. This finding shows that grouping based on different ages does not affect the choice of the prostate biopsy method.…”

Section: Discussionmentioning

confidence: 84%

“…Therefore, only a few biopsy cores are sufficient to reach a diagnosis. In contrast, for patients with a PSA concentration of less than 20 ng/mL, the tumors are mostly focal, and increased numbers of biopsy sites are conducive to tumor detection …”

Section: Discussionmentioning

confidence: 98%

How Many Cores Does Systematic Prostate Biopsy Need?: A Large‐Sample Retrospective Analysis

Wang

Sun

et al. 2018

J of Ultrasound Medicine

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Objectives To explore the best individualized systematic prostate biopsy method. Methods We retrospectively analyzed the clinical data of 1211 patients who underwent 12‐core systematic prostate biopsy guided by transrectal ultrasound from January 2011 to March 2018. Other biopsy core methods (6‐, 8‐, and 10‐core) were estimated from the 12‐core biopsy that was performed. Differences in the detection rates of prostate cancer (PCa) and clinically significant prostate cancer (csPCa) were compared. Results A total of 498 cases of PCa (41.1%) were detected, and 423 cases (34.9%) were csPCa. There was no significant difference between the 12‐ and 10‐core prostate biopsy strategies in the total detection rates of PCa and csPCa (P > .05). In the subgroup of patients with a maximal prostate cross‐sectional area of less than 15 cm2, there was a significant difference between the 12‐core method and the standard 6‐core method (P = .03) but no significant differences between the other methods in the detection rate of PCa (P > .05), but in the detection rate of csPCa, the 12‐core method differed significantly from the other methods (P = .02–.04) except for the 10‐core method (P > .05). In patients with a prostate‐specific antigen concentration of 20 ng/mL or higher, there were no significant differences between the 12‐core method and all of the other methods (P > 0.05). In patients younger than 70 years and 70 years or older, the 12‐core method differed significantly from the other methods (P < .01–.03) except for the 10‐core method (P > .05). Conclusions Ten‐ or 12‐core biopsy showed a higher detection rate than the other schemes. However, for patients with a prostate‐specific antigen concentration of 20 ng/mL or higher, the 6‐core systematic biopsy is preferred.

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Prostate-specific Antigen Parameters and Prostate Health Index Enhance Prostate Cancer Prediction With the In-bore 3-T Magnetic Resonance Imaging-guided Transrectal Targeted Prostate Biopsy After Negative 12-Core Biopsy

Cited by 22 publications

References 25 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

PHI density prospectively improves prostate cancer detection

How Many Cores Does Systematic Prostate Biopsy Need?: A Large‐Sample Retrospective Analysis

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