Combining Prostate Health Index density, magnetic resonance imaging and prior negative biopsy status to improve the detection of clinically significant prostate cancer

Druskin, Sasha C.; Tosoian, Jeffrey J.; Young, Allen; Collica, Sarah; Srivastava, Arnav; Ghabili, Kamyar; Macura, Katarzyna J.; Carter, H. Ballentine; Partin, Alan W.; Sokoll, Lori J.; Ross, Ashley E.; Pavlovich, Christian P.

doi:10.1111/bju.14098

Cited by 82 publications

(60 citation statements)

References 36 publications

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“…Druskin et al [27] evaluated the combination of PHID (retrospectively calculated as phi divided by prostate volume measured at biopsy) and multi-parametric MRI (mp-MRI) in 104 subjects: Pi-RADS ≥ 3 combined with PHID ≥ 0.44 identified nearly 100% csPCa.…”

Section: Phi-density (Phid)mentioning

confidence: 99%

Beyond PSA: The Role of Prostate Health Index (phi)

Ferro

Cobelli

Lucarelli

et al. 2020

IJMS

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Background: Widespread use of prostate specific antigen (PSA) in screening procedures allowed early identification of an increasing number of prostate cancers (PCas), mainly including indolent cancer. Availability of different therapeutic strategies which have a very different impact on the patient's quality of life suggested a strong need for tools able to identify clinically significant cancer at diagnosis. Multi-parametric magnetic resonance showed very good performance in pre-biopsy diagnosis. However, it is an expensive tool and requires an experienced radiologist. In this context, a simple blood-based test is worth investigating. In this context, researchers focused their attention on the development of a laboratory test able to minimize overdiagnosis without losing the identification of aggressive tumors. Results: Recent literature data on PCa biomarkers revealed a clear tendency towards the use of panels of biomarkers or a combination of biomarkers and clinical variables. Phi, the 4Kscore, and Stockholm3 as circulating biomarkers and the Mi-prostate score, Exo DX Prostate, and Select MD-X as urinary biomarker-based tests have been developed. In this scenario, phi is worthy of attention as a noninvasive test significantly associated with aggressive PCa. Conclusions: Literature data showed that phi had good diagnostic performance to identify clinically significant (cs) PCa, suggesting that it could be a useful tool for personalized treatment decision-making. In this review, phi potentialities, limitations, and comparisons with other blood-and urinary-based tests were explored.

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Section: Phi-density (Phid)mentioning

confidence: 99%

Beyond PSA: The Role of Prostate Health Index (phi)

Ferro

Cobelli

Lucarelli

et al. 2020

IJMS

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“…In the last years, the application and standardization of mpMRI was shown to lead to a notable improvement in early PCa diagnosis. A combination of mpMRI and PHID for the detection of clinically significant carcinomas with a concomitant reduction in unnecessary biopsies is plausible and was described by Druskin et al [15] in 2018, who conducted a study in 241 patients. For reasons of cost efficiency, however, the application of PHID (cost: approx.…”

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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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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“…Recently Druskin et al reported the combination of mpMRI and PHI density (PHID), as retrospectively determined by the ratio of PHI and prostate volume measured on transrectal ultrasonography at biopsy, to predict biopsy outcome [32]. In a series of 104 men, PI-RADS ≥ 3 or PHI density (PHID) ≥ 0.44 could detect 100% of csPC.…”

Section: Discussionmentioning

confidence: 99%

Combining prostate health index and multiparametric magnetic resonance imaging in the diagnosis of clinically significant prostate cancer in an Asian population

Hsieh

Lin

et al. 2019

World J Urol

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Objective To evaluate the practicability of combining prostate health index (PHI) and multiparametric magnetic resonance imaging (mpMRI) for the detection of clinically significant prostate cancer (csPC) in an Asian population. Patients and methodsWe prospectively enrolled patients who underwent prostate biopsy due to elevated serum prostatespecific antigen (PSA > 4 ng/mL) and/or abnormal digital rectal examination in a tertiary referral center. Before prostate biopsy, the serum samples were tested for PSA, free PSA, and p2PSA to calculate PHI. Besides, mpMRI was performed using a 3-T scanner and reported in the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2). The diagnostic performance of PHI, mpMRI, and combination of both was assessed. Result Among 102 subjects, 39 (38.2%) were diagnosed with PC, including 24 (23.5%) with csPC (Gleason ≥ 7). By the threshold of PI-RADS ≥ 3, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to predict csPC were 100%, 44.9%, 35.8%, and 100%, respectively. By the threshold of PHI ≥ 30, the sensitivity, specificity, PPV, and NPV to predict csPC were 91.7%, 43.6%, 33.3%, and 94.4%, respectively. The area under the receiver operator characteristic curve of combining PHI and mpMRI was greater than that of PHI alone (0.873 vs. 0.735, p = 0.002) and mpMRI alone (0.873 vs. 0.830, p = 0.035). If biopsy was restricted to patients with PI-RADS 5 as well as PI-RADS 3 or 4 and PHI ≥ 30, 50% of biopsy could be avoided with one csPC patient being missed. Conclusion The combination of PHI and mpMRI had higher accuracy for detection of csPC compared with PHI or mpMRI alone in an Asian population.

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Combining Prostate Health Index density, magnetic resonance imaging and prior negative biopsy status to improve the detection of clinically significant prostate cancer

Cited by 82 publications

References 36 publications

Beyond PSA: The Role of Prostate Health Index (phi)

Beyond PSA: The Role of Prostate Health Index (phi)

Use of the Prostate Health Index and Density in 3 Outpatient Centers to Avoid Unnecessary Prostate Biopsies

Combining prostate health index and multiparametric magnetic resonance imaging in the diagnosis of clinically significant prostate cancer in an Asian population

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