Modified Prostate Health Index Density Significantly Improves Clinically Significant Prostate Cancer (csPCa) Detection

Chen, Haojie; Qian, Yuhang; Wu, Yanyuan; Shi, Bowen; Zhou, Jun; Qu, Fajun; Gu, Zhengqin; Ding, Jie; Yu, Yongjiang

doi:10.3389/fonc.2022.864111

Cited by 6 publications

(6 citation statements)

References 37 publications

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“…19 However, contrasting findings have been reported on the ability of PHI and PHID to detect csPCa defined after radical prostatectomy. 20 In our study, PHID and p2PSA/fPSAD showed the highest AUC for csPCa defined with both classification (for csPCa as GG ≥ 2, AUC 0.737, 0.736; for csPCa as GG ≥ 3, AUC 0.668, 0.670, respectively), but did not significantly differ from that of PHI and p2PSA/fPSAratio (for csPCa as GG ≥ 2, p = 0.409, 0.180 and for csPCa as GG ≥ 3, p = 0.558, 0.087, respectively). Further studies on larger population are needed to better address this issue.…”

Section: Discussionmentioning

confidence: 99%

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

Ferro,

Crocetto,

La Civita

et al. 2024

The Prostate

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BackgroundThere is a strong clinical need to fill the gap of identifying clinically significant prostate cancer (csPCa) in men with prostate‐specific antigen (PSA) gray zone values. Promising, but not definitive results have been obtained using PSA derivatives such as prostate health index (PHI) and PHI density (PHID) and the percentage (‐2)proPSA/free PSA (%p2PSA/fPSA). Thus, this study aimed to compare the diagnostic value of PHI, PHID, %proPSA/fPSA, and (‐2)proPSA/freePSA density (‐2pPSA/fPSAD) for csPCa in the patients with PSA within 2–10 ng/mL.MethodsSerum samples and clinicopathological features were prospectively collected from 142 patients who underwent robot‐assisted radical prostatectomy between September 2021 and December 2023. According to the inclusion criteria, the patients with total PSA within 2 and 10 ng/mL and negative or suspicious digital rectal examination were enrolled. We used two different classifications for csPCa: 1) patients with Gleason score (GS) ≥ 7(4 + 3) and 2) patients with GS ≥ 7(3 + 4). The receiver operating characteristic curves and the area under the curve (AUC) values were used to assess the diagnostic performance.ResultsOf the 142 men included, 116 (82%) patients were diagnosed with csPCa as GS ≥ 3 + 4 and 107 (75%) defined as csPCa as GS ≥ 7(4 + 3), respectively. We found that p2PSA/fPSA, p2PSA/fPSAD, PHI, and PHID were significantly higher in csPCa classified as GS ≥ 7(3 + 4) as well as GS ≥ 7(4 + 3), with p‐values 0.027, 0.054, 0.0016, and 0.0027, respectively. AUCs of the analyzed variables were higher when used to predict csPCa as GS ≥ 6 compared to csPCa as GS ≥7(4 + 3), with an AUC equal, respectively, to 0.679 (95% CI: 0.571–0.786), 0.685 (95% CI: 0.571–0.799), 0.737 (95% CI: 0.639–0.836), and 0.736 (95% CI: 0.630–0.841) in the first subgroup and with an AUC equal, respectively, to 0.653 (95% CI: 0.552–0.754), 0.665 (95% CI: 0.560–0.770), 0.668 (95% CI: 0.568–0.769), and 0.670 (95% CI: 0.567–0.773) in the second, respectively. Both PHID and p2PSA/fPSAD allowed improvement in the diagnostic accuracy with respect to PHI and p2PSA/fPSA ratio, however the differences were not statistically significant (p = 0.409, 0.180 for csPCa as G ≥ Gleason grade (GG) 2 and 0.558 and 0.087 for csPCa as G ≥ GG3, respectively). We found that PHI, PHID, p2PSA/fPSA ratio, and p2PSA/fPSAD showed higher sensitivity, specificity, and positive predictive value when used to predict csPCa as GG ≥ 2, whereas negative predictive value of all four parameters was higher when used to predict GG ≥ 3.ConclusionsIn men with a PSA level between 2 and 10 ng/mL, PHI and PHID, p2PSA/fPSA, and p2PSA/fPSAD showed good diagnostic performance for postoperative csPCa. However, PHID and p2PSA/fPSAD had a small advantage over PHI which needs to be further investigated for the reduction of unnecessary surgical interventions. This finding suggests that it could be a promising biomarker for making the treatment‐decision strategy.

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Section: Discussionmentioning

confidence: 99%

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

Ferro,

Crocetto,

La Civita

et al. 2024

The Prostate

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“…The treatment strategy for patients with nonsignificant PCa includes watchful waiting and active surveillance, with only csPCa patients requiring curative treatment (10). Therefore, the screening of csPCa becomes an important part of the treatment strategy (15). Studies have shown that approximately 75% of patients undergo unnecessary prostate biopsies based on PSA values only (16,17).…”

Section: Discussionmentioning

confidence: 99%

Comparisons of the diagnostic accuracy across prostate health index, prostate health index density, and percentage free prostate-specific antigen for clinically significant prostate cancer: a prospective diagnostic study

Wu¹,

Shao²,

Lin³

et al. 2023

Transl Androl Urol

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Background: As the novel serum biomarkers, it has not been clearly clarified that the diagnostic accuracy of prostate health index (PHI) and prostate health index density (PHID) are superior to that of percentage free prostate-specific antigen (%fPSA) in detection of clinically significant prostate cancer (csPCa), especially in the gray zone. Therefore, this study aimed to compare the diagnostic value of PHI, PHID, and %fPSA for csPCa in the patients with prostate-specific antigen (PSA) >4 ng/mL and those with PSA within 4-10 ng/mL.Methods: In this study, the serum samples and clinicopathological features were prospectively obtained from the patients who underwent prostate biopsy between September 2019 and December 2020. According to the inclusion criteria, the patients with total PSA (tPSA) >4 ng/mL, prostate magnetic resonance imaging or ultrasound clearly suggesting an occupying lesion were enrolled in this study. The patients with Gleason score ≥7 indicated csPCa. The receiver operating characteristic curves and the area under the curve (AUC) values were used to assess the diagnostic performance.Results: Among the 296 patients (mean age 67.5 years, median tPSA 7.94 ng/mL) included in this study, there were 54 in the csPCa group (mean age 70.4 years, median tPSA 11.0 ng/mL) and 242 in the non-csPCa group (mean age 66.8 years, median tPSA 7.67 ng/mL). Based on the PSA level, there were 198 patients with PSA within the gray zone, which included 40 patients in the csPCa group and 158 in the non-csPCa group.In all patients, the sensitivity of PHID for detecting csPCa was 96.30%, and the specificity was 33.06% with the cut-off value of 0.51. Moreover, both PHID and PHI did better in the diagnosis of csPCa (AUC: 0.880 and 0.867, respectively) compared with other PSA derivative markers. Similarly, in the patients with PSA level in the gray zone, the diagnostic accuracy of PHID and PHI in predicting csPCa (AUC: 0.788 and 0.777, respectively) were better than other PSA derivative markers.Conclusions: PHID presented the better diagnostic accuracy in predicting csPCa in patients with PSA in the gray zone than other PSA derivative markers, which could be a promising biomarker for making the biopsy strategy.

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“…12 Besides, to reduce the potential bias caused by serological category indicators alone, more researchers have searched for extra serum-based indices or brought prostatic morphological parameters from TRUS or multiparametric magnetic resonance imaging to optimize prediction models, including serum cytokines, PSA density (PSAD), PSAD modified by prostate transition zone volume (PSATZD), PHID, modified PHI density (mPHID), and other multivariable predictive models. [13][14][15][16][17] Noteworthy, several studies have reported that incorporating the prostate transition zone volume (PTZV) as a supplementary component of a PSA-based predictive model can effectively decrease the number of unnecessary biopsies while simultaneously maintaining a high level of sensitivity in detecting PCa. 15,18,19 The tPSA, however, is more prostate organ-specific rather than cancerspecific and is often associated with peripheral zone (PZ) cancer rather than TZ hyperplasia.…”

Section: Evaluating the Role Of Morphological Parameters In The Prost...mentioning

confidence: 99%

Evaluating the Role of Morphological Parameters in the Prostate Transition Zone in PHI-Based Predictive Models for Detecting Gray Zone Prostate Cancer

Qian,

Shi,

Sheng

et al. 2023

Clin Med Insights Oncol

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Background: The early detection of clinically significant prostate cancer (csPCa) through the integration of multidimensional parameters presents a promising avenue for improving survival outcomes for this fatal disease. This study aimed to assess the contribution of prostate transition zone (TZ) to predictive models based on the prostate health index (PHI), with the goal of enhancing early detection of csPCa in the prostate-specific antigen (PSA) gray zone. Methods: In this observational cross-sectional study, a total of 177 PSA gray zone patients (total prostate-specific antigen [tPSA] level ranging from 4.0 to 10.0 ng/mL) were recruited and received PHI detections from August 2020 to March 2022. Prostatic morphologies especially the TZ morphological parameters were measured by transrectal ultrasound (TRUS). Results: Univariable logistic regression indicated prostatic morphological parameters including total prostate volume (PV) indexes and transitional zone volume indexes were all associated with csPCa ( P < .05), while the multivariable analysis demonstrated that C-reactive protein (CRP), PHI, PHI density (PHID), and PHI transition zone density (PHI-TZD) were the 4 independent risk factors. The receiver-operating characteristic (ROC) curve analysis suggested that integrated predictive models (PHID, PHI-TZD) yield area under the curves (AUCs) of 0.9135 and 0.9105 in csPCa prediction, which shows a relatively satisfactory predictive capability compared with other predictors. Moreover, the PHI-TZD outperformed PHID by avoiding 30 patients’ unnecessary biopsies while maintaining 74.36% specificity at a sensitivity of 90%. Decision-curve analysis (DCA) confirmed the comparable performance of the multivariable full-risk prediction models, without the inclusion of the net benefit, thereby highlighting the superior diagnostic efficacy of PHID and PHI-TZD in comparison with other diagnostic models, in both univariable and multivariable models. Conclusion: Our data confirmed the value of prostate TZ morphological parameters and suggested a significant advantage for the TZ-adjusted PHI predictive model (PHI-TZD) compared with PHI and PHID in the early detection of gray zone csPCa under specific conditions.

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Modified Prostate Health Index Density Significantly Improves Clinically Significant Prostate Cancer (csPCa) Detection

Cited by 6 publications

References 37 publications

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

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

Comparisons of the diagnostic accuracy across prostate health index, prostate health index density, and percentage free prostate-specific antigen for clinically significant prostate cancer: a prospective diagnostic study

Evaluating the Role of Morphological Parameters in the Prostate Transition Zone in PHI-Based Predictive Models for Detecting Gray Zone Prostate Cancer

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