The prostate health index PHI predicts oncological outcome and biochemical recurrence after radical prostatectomy - analysis in 437 patients

Abstract

The purpose of this study was to investigate the Prostate-Health-Index (PHI) for pathological outcome prediction following radical prostatectomy and also for biochemical recurrence prediction in comparison to established parameters such as Gleason-score, pathological tumor stage, resection status (R0/1) and prostate-specific antigen (PSA).Out of a cohort of 460 cases with preoperative PHI-measurements (World Health Organization calibration: Beckman Coulter Access-2-Immunoassay) between 2001 and 2014, 437 patients with complete follow up data were included. From these 437 patients, 87 (19.9%) developed a biochemical recurrence. Patient characteristics were compared by using chi-square test. Predictors were analyzed by multivariate adjusted logistic and Cox regression.The median follow up for a biochemical recurrence was 65 (range 3-161) months. PHI, PSA, [-2]proPSA, PHI- and PSA-density performed as significant variables (p < 0.05) for cancer aggressiveness: Gleason-score <7 or ≥7 (ISUP grade 1 or ≥2) . Concerning pathological tumor stage discrimination and prediction, variables as PHI, PSA, %fPSA, [-2]proPSA, PHI- and PSA-density significantly discriminated between stages <pT3 and ≥pT3 with the highest AUC (0.7) for PHI. In biochemical recurrence prediction PHI, PSA, [-2]proPSA, PHI- and PSA-density were the strongest predictors.In conclusion, due to heterogeneity of time spans to biochemical recurrence, longer follow up periods are crucial. This study with a median follow up of more than 5 years, confirmed a clinical value for PHI as an independent biomarker essential for biochemical recurrence prediction.

Preoperative Prostate Health Index predicts adverse pathology and Gleason score upgrading after radical prostatectomy for prostate cancer.

“…The difference may be explained by the multi-institutional nature of the study, when indication criteria for prostatectomy and patients engagement in active surveillance may differ among four institutions involved. In the current study the proportion of low-risk patients with biopsy GS=6 was considerably higher (63%) in the comparison with above cited papers (36-53%), which supports our explanation [8][9]. Even though all blood samples were managed in the same standardized way at each contributing institution, the data might be in uenced by preanalytical and analytical bias.…”

“…These results were con rmed in a multicenter study performed in 489 patients; however, decision curve analysis did not prove greater clinical net bene t of prediction models incorporating PHI [8]. A recent single center study in 437 patients described lower predictive power of PHI in prediction of GS≥7 (AUC=65) and/or pT3 disease (AUC=70), however the authors suggests PHI to be independent predictor of biochemical recurrence after radical prostatectomy (AUC=62) [9]. Our results con rm the ability of PHI to predict GS≥7 (AUC=65) and/or pT3 disease (AUC=60).…”

“…This nding was later con rmed in a multicenter study; however, decision curve analysis did not prove greater clinical net bene t of prediction models incorporating PHI [8]. A recent single center study in 437 patients suggests PHI to be not only good diagnostic tool, but an independent predictor of biochemical recurrence after RP [9].…”

Beyond PSA: The Role of Prostate Health Index (phi)

“…Recently, Maxeiner et al [41] showed in a study population of 437 patients with a longer than 5-year follow-up that phi is the most accurate predictor of BCR with an AUC of 0.623 [0.559-0.688] versus PSA of 0.59 (p < 0.001).…”

“…Follow-up AS [22] Predicting BCR Lughezzani, 2015 313 Follow-up after RARP [40] Maxeiner, 2017 437 Follow-up after RP [41] RP, radical prostatectomy, AS, active surveillance, BCR, biochemical recurrence, RARP, robotic-assisted radical prostatectomy.…”