A total of 1185 European (Munster, Hamburg, Paris, Rennes) and 1319 Asian (Hong Kong, Shanghai, Singapore, Taipei, Taichung) men with PHI and transrectal 10-12 core systematic prostate biopsy performed were included. No patient had prior PCa diagnosis, MRI or targeted biopsy. PC in general and Gleason score (GS) >=7 PC specifically across different PHI ranges were compared.
Overall, 503 European and 1150 Asian men were within the core PHI indication of PSA 2-10, normal digital rectal examination (DRE) and initial biopsy.
Table 1 demonstrates their characteristics:
| European |
Asian |
p-value |
|
| Age |
63.2±7.1 |
65.3±7.5 |
<0.001 |
| TRUS volume(ml) |
45.8±22.7 |
46.7±21.1 |
0.447 |
| PSA(ng/ml) |
5.2±1.6 |
6.6±1.7 |
<0.001 |
| PHI |
53.4±35.4 |
31.2±12.7 |
<0.001 |
| PCa |
262(52.1%) |
151(13.1%) |
<0.001 |
| HGPCa |
108(21.5%) |
66 (5.7%) |
<0.001 |
PC and PC with GS >=7 were 4 times more common in European men than in Asian men. PHI predicted higher PC risk in both groups. PC with GS >=7 was found in only 3.6% (6/165) European and 1.5% (12/810) of Asian men with PHI<35.
In European at 90% sensitivity for PC with GS>=7 (PHI 37.7), 38% unnecessary biopsies and 30% Gleason 6 cancer diagnosis could have been avoided. In Asian at 90% sensitivity for PC with GS>=7 (PHI 30.3), 56% biopsies and 33% Gleason 6 cancer diagnosis could have been avoided. The AUC for PC with GS>=7 was 0.64 for PSA and 0.71 for PHI in Europeans, while for Asians it was 0.56 for PSA and 0.84 for PHI.
In both cohorts, PHI was equally effective in men with abnormal DRE (n=335), repeated biopsy(n=445), and PSA 10-20 (n=75).
In conclusion, PHI is effective in cancer risk stratification in both European and Asian men. A higher proportion of biopsies could be avoided in Asian men using PHI. It advisable to use specific reference ranges for each ethnic group.
Presented by: Chiu P.K., Erasmus MC, Dept. of Urology, Rotterdam, Netherlands
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, twitter: @GoldbergHanan at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark