PHI density prospectively improves prostate cancer detection

Abstract

Purpose To evaluate the Prostate Health Index (PHI) density (PHID) in direct comparison with PHI in a prospective large cohort. Methods PHID values were calculated from prostate-specific antigen (PSA), free PSA and [− 2]proPSA and prostate volume. The 1057 patients included 552 men with prostate cancer (PCa) and 505 with no evidence of malignancy (NEM). In detail, 562 patients were biopsied at the Charité Hospital Berlin and 495 patients at the Sana Hospital Offenbach. All patients received systematic or magnetic resonance imaging (MRI)/ultrasound fusion-guided biopsies. The diagnostic accuracy was evaluated by receiver operating characteristic (ROC) curves comparing areas under the ROC-curves (AUC). The decision curve analysis (DCA) was performed with the MATLAB Neural Network Toolbox. Results PHID provided a significant larger AUC than PHI (0.835 vs. 0.801; p = 0.0013) in our prospective cohort of 1057 men from 2 centers. The DCA had a maximum net benefit of ~ 5% for PHID vs. PHI between 35 and 65% threshold probability. In those 698 men within the WHO-calibrated PSA grey-zone up to 8 ng/ml, PHID was also significantly better than PHI (AUC 0.819 vs. 0.789; p = 0.0219). But PHID was not different from PHI in the detection of significant PCa. Conclusions Based on ROC analysis and DCA, PHID had an advantage in comparison with PHI alone to detect any PCa but PHI and PHID performed equal in detecting significant PCa.

The prostate health index (PHI) density: Are there advantages over PHI or over the prostate-specific antigen density?

“…For the same PSA range used in our study, be- PSA prostate-specific antigen, PHI prostate health index, PSAD prostate-specific antigen density, PHID prostate health index density, CI confidence interval, PPV positive predictive value, NPV negative predictive value, PCa prostate cancer, csPCa clinically significant prostate cancer. and PHID (0.835) quite similar to those we have found in our study cohort (PSAD: 0.776; PHID: 0.823) [16].…”

“…For the same diagnostic sensitivity of approximately 90%, PHID can provide only a small gain in specificity when compared to PHI alone (39.6% versus 35.8%). Stephan et al performed a similar study, however considering only the GS to define csPCa (GS ≥ 7), and concluded that PHI and PHID performed equally in detecting csPCa, based only on the values of the AUCs [16]. Our results also show almost the same performance between PHI and PHID for csPCa detection.…”

“…In a similar way to what happens with PSAD, and certainly based on the same logical mechanism that explains its utility [14], a few authors have recently explored the hypothesis that PHI density (PHID) -the PHI value divided by the volume of the prostatecould improve even further the diagnostic performance of PHI. Their results have been promising so far [15][16]. It has also been reported that, in patients with a PSA level below 10 µg/L, PHI has an improved performance in smaller prostate glands (≤35 cc), meaning that the prostate volume has an impact on PHI performance [17].…”

Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection

“…A large retrospective cohort study demonstrated that PHID had similar AUC as PHI and had a small advantage on decision curve analysis than PHI alone in predicting overall PCa (54). Stephan et al found PHID had significantly larger AUC than PHI in predicting overall PCa but no significant difference from PHI if aiming for csPCa (55). In our study, the AUC of PHID is significantly better than PHI in predicting csPCa (p=0.004, Figure 1B).…”

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

“…It is necessary to comprehensively consider the situation of the patient and then fit different image parameters to optimize the predicting model. Currently, though PHID has been proven to better identify PCa within the PSA gray zone ( 23 ), the modality still possesses limitations. Above all, bias in results will come upon when using the tPV as a normalized control for PHID or PSAD.…”