Routine use of Prostate Health Index (PHI) reduces majority of unnecessary prostatic biopsies in Asian men: A prospective study in 2795 men seen at Urology clinics

Chiu, Peter Ka Fung; Roobol, Monique J.; Teoh, Jeremy Yuen Chun; Lau, Benjamin; Yee, Chi Hang; Hou, See‐Ming; Ho, Christopher C.K.; Tang, Wei; Poon, Wing-Tat; Bangma, C.; Ng, Chi Fai

doi:10.1016/s1569-9056(18)33762-x

Cited by 2 publications

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“…In the local experience of Hong Kong, PHI has routinely been used in men with elevated PSA in the public health care system since 2016, and the cost of PHI has been reduced to less than USD $100 per test. 25,26 Similarly in Singapore, PHI has been routinely offered to men with elevated PSA 4-10 ng/mL at the 2 hospitals in this paper since 2017; estimated charges ranged from USD $44-$109 depending on subsidies available. 27,28 The total health care cost could be reduced as more biopsies could be avoided by using PHID instead of PSAD, especially in men with PI-RADS 3 lesions.…”

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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Section: Discussionmentioning

confidence: 99%