Prostate Health Index (PHI) Predicts High-stage Pathology in African American Men

Schwen, Zeyad; Tosoian, Jeffrey J.; Sokoll, Lori J.; Mangold, Leslie A.; Humphreys, Elizabeth B.; Schaeffer, Edward M.; Partin, Alan W.; Ross, Ashley E.

doi:10.1016/j.urology.2015.12.004

Cited by 16 publications

(2 citation statements)

References 28 publications

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“…Finally, we used biopsy endpoints to determine disease aggressiveness because biopsy results are used to make initial treatment decisions and are therefore useful endpoints for biomarker studies. Nevertheless, the present results are consistent with several other studies showing that PHI also predicts adverse pathology in the radical prostatectomy specimen .…”

Section: Discussionsupporting

confidence: 93%

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: Discussionsupporting

confidence: 93%

Prostate Health Index improves multivariable risk prediction of aggressive prostate cancer

et al. 2016

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“…A recent prospective trial found that the 4K score outperformed a base model incorporating PSA for AA and demonstrated that the 4K score accurately predicts aggressive prostate cancer and outperforms standard clinical parameters for biopsy decision-making in AA men ( 27 ). Prostate health index (PHI) is another measure that has been shown to adequately identify prostate tumors with extraprostatic extension in an evaluation of 80 AA men with prospective evaluation prior to prostatectomy ( 28 ). However, no other studies have shown value of PHI as a screening tool.…”

Section: Diagnostic Modalities For Prostate Cancer In African Americamentioning

confidence: 99%

Rethinking active surveillance for prostate cancer in African American men

Leinwand

Gabrielson

Krane

et al. 2018

Transl. Androl. Urol.

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Active surveillance (AS) is a treatment modality for prostate cancer that aims to simultaneously avoid overtreatment and allow for the timely intervention of localized disease. AS has become the de facto standard of care for most men with low-risk prostate cancer. However, few African American (AA) men were included in the prospective observational cohorts that resulted in a paradigm shift in treatment recommendations from active intervention toward AS. It has been established that AA men have an increased prostate cancer incidence, higher baseline prostate-specific antigen (PSA) values, more aggressive prostate cancer features, greater frequency of biochemical recurrence after treatment, and higher overall cancer-specific mortality compared to their Caucasian counterparts. As such, this has given many physicians pause before initiating AS for AA patients. In the following manuscript, we will review the available literature regarding AS, with a particular focus on AA men. The preponderance of evidence demonstrates that AS is as viable a management method for AA with low-risk prostate cancer as it is with other racial groups.

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