Comparison of Prostate-Specific Antigen and Its Density and Prostate Health Index and Its Density for Detection of Prostate Cancer

Abstract

As the incidence of prostate cancer (PCa) has increased, screening based on prostate-specific antigen (PSA) has become controversial due to the low specificity of PSA. Therefore, we investigated the diagnostic performance of prostate health index (PHI) density (PHID) for the detection of PCa and clinically significant PCa (csPCa) compared to PSA, PSA density (PSAD), and PHI as a triaging test. We retrospectively reviewed 306 men who underwent prostate biopsy for PSA levels of 2.5 to 10 ng/mL between January 2020 and April 2023. Of all cohorts, 86 (28.1%) and 48 (15.7%) men were diagnosed with PCa and csPCa, respectively. In ROC analysis, the highest AUC was identified for PHID (0.812), followed by PHI (0.791), PSAD (0.650), and PSA (0.571) for PCa. A similar trend was observed for csPCa: PHID (AUC 0.826), PHI (AUC 0.796), PSAD (AUC 0.671), and PSA (0.552). When the biopsy was restricted to men with a PHID ≥ 0.56, 26.5% of unnecessary biopsies could be avoided; however, 9.3% of PCa cases and one csPCa case (2.1%) remained undiagnosed. At approximately 90% sensitivity for csPCa, at the given cut-off values of PHI ≥ 36.4, and PHID ≥ 0.91, 48.7% and 49.3% of unnecessary biopsies could be avoided. In conclusion, PHID had a small advantage over PHI, about 3.6%, for the reduction in unnecessary biopsies for PCa. The PHID and PHI showed almost the same diagnostic performance for csPCa detection. PHID can be used as a triaging test in a clinical setting to pre-select the risk of PCa and csPCa.

Serum (‐2)proPSA/freePSAratio, (‐2)proPSA/freePSA density, prostate health index, and prostate health index density as clues to reveal postoperative clinically significant prostate cancer in men with prostate‐specific antigen 2–10 ng/mL

“…In a study by Chiu et al, at 90% sensitivity, 43.7% of unnecessary biopsies could be avoided when the PHID was >0.67 23 . Boo et al 19 showed that with a cutoff of PHID ≥ 0.91, PHID had a 56.2% specificity, and 49.3% of unnecessary biopsies could be avoided at the cost of 8.3% of csPCa. In this study, when applying the optimal biomarkers cutoffs, the PPV of PHI, PHID, p2PSA/fPSA, p2PSA/fPSAD was 91%, 90%, 92%, and 90% for csPCa, respectively.…”

“…For the first time in 2014, by analogy with PSA density, PHID was introduced 17 . Tosoian et al 18 evaluated the ability of PHID in 118 men underwent first biopsy showing that PHID had the highest ability to identify csPCa (AUC 0.84), allowing to avoid 38% of unnecessary biopsies and missing only 2% of csPCa 19 …”

Advances in multiparametric magnetic resonance imaging combined with biomarkers for the diagnosis of high-grade prostate cancer

“…Similar to PSAD, the diagnostic performance of PHID is limited by the PV, which is indicated for patients with a PV ≤ 50 cm 3 ( 34 ). In 306 patients with a median PV of 37.9 cm 3 and PSA 4–10 ng/ml, PHID diagnosed HGPCa with an AUC of up to 0.826, which is superior to PSA, PSAD, and PHI ( 35 ). In the group of patients with a PV > 50 cm 3 , PHID demonstrated a diagnostic power similar to PSA (AUC: 0.686 vs. 0.700, respectively) ( 34 ).…”