Mp6-06 Prostate Health Index Predicts Upgrading of Men on 5-Alpha Reductase Inhibitors

Crawford, E. David; Arangua, Paul; Jones, Clifford; Poage, Wendy; Stone, Nelson N.; Rosa, Francisco G. La; Loeb, Stacy; Werahera, Priya N.

doi:10.1016/j.juro.2015.02.253

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“…In the present study we also excluded men taking finasteride; however, emerging data suggest that PHI may also work in this population . In addition, only 5.4% of the study population was African‐American, and data on family history were not available; therefore, these factors should be incorporated into future refinements of the model.…”

Section: Discussionmentioning

confidence: 99%

Prostate Health Index improves multivariable risk prediction of aggressive prostate cancer

et al. 2016

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Objective To examine the use of the Prostate Health Index (phi)* as a continuous variable in multivariable risk assessment for aggressive prostate cancer in a large multicenter US study. Materials and Methods The study population included 728 men with PSA levels of 2-10 ng/mL and negative digital rectal examination enrolled in a prospective, multi-site early detection trial. The primary endpoint was aggressive prostate cancer, defined as biopsy Gleason score ≥7. First, we evaluated whether the addition of phi improves the performance of currently available risk calculators (PCPT and ERSPC). We also designed and internally validated a new phi-based multivariable predictive model, and created a nomogram. Results Of 728 men undergoing biopsy, 118 (16.2%) had aggressive prostate cancer. Phi predicted the risk of aggressive prostate cancer across the spectrum of values. Adding phi significantly improved the predictive accuracy of the PCPT and ERSPC risk calculators for aggressive disease. A new model was created using age, prior biopsy, prostate volume, PSA, and phi with an AUC of 0.746. The bootstrap-corrected model showed good calibration with observed risk for aggressive prostate cancer and had net benefit on decision curve analysis. Conclusion Using phi as part of multivariable risk assessment leads to a significant improvement in the detection of aggressive prostate cancer, potentially reducing harms from unnecessary prostate biopsy and overdiagnosis.

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Section: Discussionmentioning

confidence: 99%