scholarly journals 1226 The Clinical Utility of Prostate Health Index Density in The Diagnosis of Clinically Significant Prostate Cancer: A Systematic Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
E Tezcan ◽  
O Abdalla
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Diagnostic Test ◽  
Clinical Utility ◽  
Health Index ◽  
Quality Appraisal ◽  
Psa Testing ◽  
Prostate Health Index ◽  
Clinically Significant ◽  
Prostate Health

Abstract Aim Prostate health index (PHI) is a diagnostic test for prostate cancer that combines free prostate specific antigen (PSA), total PSA and [-2]proPSA. PHI has been shown to be more accurate than PSA testing at detecting prostate cancer and its use has been shown to reduce unnecessary prostate biopsies. Prostate health index density (PHID), derived by dividing PHI by prostate volume, has been suggested as a more accurate test compared to standard PHI by several authors. The aim of this systematic review was to evaluate the diagnostic accuracy of PHID for clinically significant prostate cancer, identify an optimal diagnostic threshold and assess the clinical utility of PHID as a novel diagnostic test for prostate cancer. Method A systematic review of primary studies was conducted. Medline, Embase, Scopus and Cochrane databases were searched with key terms. Results were screened and full papers reviewed by two reviewers with pre-determined inclusion criteria. QUADAS-2 was used for quality appraisal. Data analysis was conducted in line with PRISMA guidelines. Results Nine studies were included. Quality appraisal revealed a high degree of heterogeneity between studies. PHID thresholds ranged 0.32-1.38. PHID had an area under the curve value of 0.59-0.9 and negative predictive value of 81-100% for clinically significant disease. PHID outperformed PHI in three studies, but this was not replicated in the other studies. Conclusions This systematic review found PHID did not consistently outperform PHI. PHID was found to have low clinical utility in the diagnosis of prostate cancer based on the available evidence, with further research warranted.

scholarly journals Prostate Health Index and Multiparametric MRI: Partners in Crime Fighting Overdiagnosis and Overtreatment in Prostate Cancer

Cancers ◽  
2021 ◽  
Vol 13 (18) ◽  
pp. 4723
Author(s):  
Matteo Ferro ◽  
Felice Crocetto ◽  
Dario Bruzzese ◽  
Massimo Imbriaco ◽  
Ferdinando Fusco ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Volume ◽  
High Rate ◽  
Health Index ◽  
Positive Biopsy ◽  
Prostate Health Index ◽  
Standard Tool ◽  
Comparable Performance ◽  
Clinically Significant ◽  
Prostate Health

Widespread use of PSA as the standard tool for prostate cancer (PCa) diagnosis led to a high rate of overdiagnosis and overtreatment. In this study, we evaluated the performance of the prostate health index (PHI) and multiparametric magnetic resonance imaging (mpMRI) for the prediction of positive biopsy and of high-grade PCa at radical prostatectomy (RP). To this end, we prospectively enrolled 196 biopsy-naïve patients who underwent mpMRI. A subgroup of 116 subjects with biopsy-proven PCa underwent surgery. We found that PHI significantly outperformed both PI-RADS score (difference in AUC: 0.14; p < 0.001) and PHI density (difference in AUC: 0.08; p = 0.002) in the ability to predict positive biopsy with a cut-off value of 42.7 as the best threshold. Conversely, comparing the performance in the identification of clinically significant prostate cancer (csPCa) at RP, we found that PHI ≥61.68 and PI-RADS score ≥4 were able to identify csPCa (Gleason score ≥7 (3 + 4)) both alone and added to a base model including age, PSA, fPSA-to-tPSA ratio and prostate volume. In conclusion, PHI had a better ability than PI-RADS score to predict positive biopsy, whereas it had a comparable performance in the identification of pathological csPCa.

scholarly journals The Prostate Health Index aids multi-parametric MRI in diagnosing significant prostate cancer

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yu-Hua Fan ◽  
Po-Hsun Pan ◽  
Wei-Ming Cheng ◽  
Hsin-Kai Wang ◽  
Shu-Huei Shen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Predictive Power ◽  
Transrectal Ultrasound ◽  
Health Index ◽  
Prostate Imaging ◽  
Prostate Biopsies ◽  
Prostate Health Index ◽  
Clinically Significant ◽  
Prostate Health

AbstractTo evaluate the performance of the Prostate Health Index (PHI) in magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion prostate biopsy for the detection of clinically significant prostate cancer (csPCa). We prospectively enrolled 164 patients with at least one Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) ≥ 3 lesions who underwent MRI-TRUS fusion prostate biopsy. Of the PSA-derived biomarkers, the PHI had the best performance in predicting csPCa (AUC 0.792, CI 0.707–0.877) in patients with PI-RADS 4/5 lesions. Furthermore, the predictive power of PHI was even higher in the patients with PI-RADS 3 lesions (AUC 0.884, CI 0.792–0.976). To minimize missing csPCa, we used a PHI cutoff of 27 and 7.4% of patients with PI-RADS 4/5 lesions could have avoided a biopsy. At this level, 2.0% of cases with csPCa would have been missed, with sensitivity and NPV rates of 98.0% and 87.5%, respectively. However, the subgroup of PI-RADS 3 was too small to define the optimal PHI cutoff. PHI was the best PSA-derived biomarker to predict csPCa in MRI-TRUS fusion prostate biopsies in men with PI-RADS ≥ 3 lesions, especially for the patients with PI-RADS 3 lesions who gained the most value.

scholarly journals The Percentage of [−2]Pro–Prostate-Specific Antigen and the Prostate Health Index Outperform Prostate-Specific Antigen and the Percentage of Free Prostate-Specific Antigen in the Detection of Clinically Significant Prostate Cancer and Can Be Used as Reflex Tests

2021 ◽  
Author(s):  
Manuel M. Garrido ◽  
José C. Marta ◽  
Rui M. Bernardino ◽  
João Guerra ◽  
Francisco Fernandes ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Accuracy ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Roc Curves ◽  
Nonparametric Tests ◽  
Health Index ◽  
Prostate Health Index ◽  
Clinically Significant ◽  
Prostate Health

Context.— There is a need to avoid the overdiagnosis of prostate cancer (PCa) and to find more specific biomarkers. Objective.— To evaluate the clinical utility of [−2]pro–prostate-specific antigen ([−2]proPSA) derivatives in detecting clinically significant PCa (csPCa) and to compare it with prostate-specific antigen (PSA) and with the percentage of free PSA (%fPSA). Design.— Two hundred thirty-seven men (PSA: 2–10 ng/mL) scheduled for a prostate biopsy were enrolled. Parametric and nonparametric tests, receiver operating characteristic (ROC) curves, and logistic regression analysis were applied. Outcomes were csPCa and overall PCa. Results.— Both [−2]proPSA derivatives were significantly higher in csPCa and overall PCa (P &lt; .001). The areas under the curves for the prediction of csPCa were higher for the percentage of [−2]proPSA (%[−2]proPSA) (0.781) and the prostate health index (PHI) (0.814) than for PSA (0.651) and %fPSA (0.724). There was a gain of 11% in diagnostic accuracy when %[−2]proPSA or PHI were added to a base model with PSA and %fPSA. Twenty-five percent to 29% of biopsies could have been spared with %[−2]proPSA (cutoff: ≥1.25%) and PHI (cutoff: ≥27), missing 10% of csPCa's. The same results could have been achieved by using [−2]proPSA as a reflex test, when %fPSA was 25% or less (cutoffs: ≥1.12% and ≥24 for %[−2]proPSA and PHI, respectively). Conclusions.— The [−2]proPSA derivatives improve the diagnostic accuracy of csPCa, when the PSA value is between 2 and 10 ng/mL, allowing to spare unnecessary biopsies and to select patients for active surveillance. [−2]proPSA can be used as a reflex test when %fPSA is 25% or less, without reducing the diagnostic accuracy for csPCa and the number of spared biopsies.

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