The Prostate Health Index aids multi-parametric MRI in diagnosing significant prostate cancer

Abstract

To evaluate the performance of the Prostate Health Index (PHI) in magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion prostate biopsy for the detection of clinically significant prostate cancer (csPCa). We prospectively enrolled 164 patients with at least one Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) ≥ 3 lesions who underwent MRI-TRUS fusion prostate biopsy. Of the PSA-derived biomarkers, the PHI had the best performance in predicting csPCa (AUC 0.792, CI 0.707–0.877) in patients with PI-RADS 4/5 lesions. Furthermore, the predictive power of PHI was even higher in the patients with PI-RADS 3 lesions (AUC 0.884, CI 0.792–0.976). To minimize missing csPCa, we used a PHI cutoff of 27 and 7.4% of patients with PI-RADS 4/5 lesions could have avoided a biopsy. At this level, 2.0% of cases with csPCa would have been missed, with sensitivity and NPV rates of 98.0% and 87.5%, respectively. However, the subgroup of PI-RADS 3 was too small to define the optimal PHI cutoff. PHI was the best PSA-derived biomarker to predict csPCa in MRI-TRUS fusion prostate biopsies in men with PI-RADS ≥ 3 lesions, especially for the patients with PI-RADS 3 lesions who gained the most value.

Improving the Early Detection of Clinically Significant Prostate Cancer in Men in the Challenging Prostate Imaging-Reporting and Data System 3 Category

“…Modern markers have been analysed in the context of the current pathway for csPCa diagnosis and are intended to avoid mpMRI scans and subsequent prostate biopsies or to select appropriate candidates for prostate biopsy after mpMRI [17] . Some of these markers are combined with clinical independent predictors in predictive models [15] , [18] . The Prostate Health Index (PHI) and PCA3 [19] , PHI [20] , [21] , 4K [22] , [23] , [24] , [25] , and the Stockholm 3 test [26] have been analysed, although their specific behaviours regarding PI-RADS categories has never been reported as a main research objective.…”

“…The Prostate Health Index (PHI) and PCA3 [19] , PHI [20] , [21] , 4K [22] , [23] , [24] , [25] , and the Stockholm 3 test [26] have been analysed, although their specific behaviours regarding PI-RADS categories has never been reported as a main research objective. Data for PHI and SelectMDx could be extracted from analyses of overall series published in the literature [18] , [27] , [28] and one specific series of men with PI-RADS 3 findings [29] . Supplementary Table 1 summarises the clinical utility of PHI [27] and SelectMDx [18] , [28] , [29] for csPCa detection in men with suspected PCa and a PI-RADS 3 lesion in comparison to Proclarix in the present study.…”

Prostate Health Index and Multiparametric MRI: Partners in Crime Fighting Overdiagnosis and Overtreatment in Prostate Cancer

“…Novel biomarkers and MRI are well-known tools useful to identify csPCa [ 19 , 20 , 22 ]. To the best of our knowledge, this study is the largest cohort study ( n = 196) centered on the evaluation of PHI and mpMRI findings according to PI-RADS version 2, which included not only patients who underwent biopsy but also a subgroup ( n = 116) of subjects treated by RP.…”

“…These findings agree with our results and support the hypothesis that PHI may be a useful tool to recognize high-grade PCa beyond MRI outcome. Recently, Fan et al [ 22 ] demonstrated that PHI, among PSA-derivative biomarkers, was the best predictor of csPCa in men with PI-RADS score 3 and 4/5. These findings suggested that in patients with PI-RADS 3 index lesions, which is a gray zone for PI-RADS v2, PHI may help to identify high-risk groups for csPCa and may enable several patients to avoid unnecessary biopsy.…”

“…Several reports indicated that the use of PHI in clinical routine, when compared with total and free PSA, produced a significant decrease in unnecessary biopsies and a reduction in the percentage of low-risk diagnosed PCa [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. However, only few authors investigated the predictive performance of PHI combined and compared with mpMRI [ 19 , 20 ] and how PHI performs in patients stratified by PI-RADS score [ 21 , 22 , 23 ]. Interestingly, some authors analyzed the ability of the combination of PHI density (the ratio between PHI value and prostate volume) and mpMRI to identify high-grade PCa [ 24 ].…”