Use of the Prostate Health Index and Density in 3 Outpatient Centers to Avoid Unnecessary Prostate Biopsies

Abstract

Objectives: We investigated the diagnostic efficacy of the prostate health index (PHI) and PHI density (PHID) to avoid unnecessary prostate biopsies in 3 urological practices. Methods: In 122 patients, total prostate-specific antigen (PSA), free PSA (f-PSA), the quotient from total PSA and f-PSA (f-PSA%), and [-2]pro-PSA were measured in the serum; PHI, PHID, and PSA density (PSAD) were calculated prior to prostate biopsy. Tissue sampling via transrectal biopsy was indicated in case of suspicious PSA (progression and/or elevation of PSA) and/or suspicious digital rectal examination. PSAD, PHI, and PHID were not used for biopsy indication. The diagnostic efficacy was determined with receiver-operating characteristic (ROC) and decision curve analyses. Results:Based on prostate biopsies, 38% (n = 46) of the cases had no prostate carcinoma (PCa), 21% (n = 26) no clinically significant (insignificant) PCa, and 41% (n = 50) had clinically significant PCa. ROC analyses of the PSA parameters showed higher diagnostic efficacy for PHI and PHID (AUC 0.722 and 0.739) than for f-PSA%, PSA, and PSAD (AUC 0.612, 0.595, and 0.698, respectively) regarding carcinoma diagnosis. With a combined use of PHI and PHID (cutoff > 40 and > 0.9, respectively), only 1 clinically significant PCa would have been missed (sensitivity 98%); in 24 (20%) patients, biopsy could have been avoided. Conclusion: The integration of PHI and PHID could improve the diagnostic efficacy of risk calculators to avoid unnecessary prostate biopsies. However, as a prerequisite, validation of cutoff values in prospective studies is urgently required.

Active Surveillance for Incidental (cT1a/b) Prostate Cancer: Long-Term Outcomes of the Prospective Noninterventional HAROW Study

“…Recently, several diagnostic procedures, such as multiparametric magnetic resonance imaging (mpMRI) or prostate health index, have become available to increase the prediction of IPC [20, 21]. On the other hand, it has so far been difficult to anticipate the occurrence of IPC after surgical treatment of BPO.…”

Prostate Cancer Liquid Biopsy Biomarkers’ Clinical Utility in Diagnosis and Prognosis

“…Another article [84] examined the diagnostic efficacy of PHI and PHID in terms of avoiding unnecessary biopsies. The results indicate that PHI (AUC = 0.722) and PHID (AUC = 0.739) have a higher diagnostic value than PSA, f-PSA% and PSAD (AUC = 0.595, 0.612 and 0.698, respectively).…”

PSA Based Biomarkers, Imagistic Techniques and Combined Tests for a Better Diagnostic of Localized Prostate Cancer

“…PSAD is defined as the PSA value divided by the volume of the prostate, with thresholds between 0.08 ng/mL/cc and 0.15 ng/mL/cc, it can be helpful in making biopsy decisions, when the PSA <10 ng/mL. It was compared with PSA in terms of diagnosing PCa, and proved to be significantly superior ( p = 0.011) [ 33 , 34 ]. Combined with PSA, fPSA, or even with mpMRI, it can help better discriminate whether to proceed with the prostate biopsy [ 35 ].…”

“…The utility of the test is that it can help reduce unnecessary biopsies, and it proved higher specificity and sensitivity than total PSA (tPSA) and free PSA% [ 1 ], with cutoff values that can range between 20–40 [ 38 , 39 ]. PHID is defined as PHI divided by prostate volume with a cutoff above 0.9 [ 34 ].…”

“…For all cancers and significant cancers, the differences between PHI, PHID vs. PSA, fPSA%, were statistically significant, but not statistically significant when PHI and PHID were compared with PSAD. With a cutoff value of >40 for PHI and >0.9 for PHID, these two tests excluded the need for biopsy for 20% of patients and only missed 1 Gleason 8 PCa, which after prostatectomy downgraded to Gleason 7(4 + 3), pT2a [ 34 ].…”