"The Utility of Prostate Specific Antigen Density, Prostate Health Index and Prostate Health Index Density in Predicting Positive Prostate Biopsy Outcome is Dependent on the Prostate Biopsy Methods".

To evaluate prognostic markers, prostate-specific antigen (PSA), prostate health index (PHI) and prostate volume indexed measures (PSAD and PHID) for predicting positive prostate cancer biopsies in magnetic resonance (MR) transrectal ultrasound fused versus non-fused transrectal ultrasonography biopsy.

A retrospective cohort of 211 patients that had at least 1 suspected MR lesion, Prostate Imaging-Reporting and Data System ≥ 3 and subsequent biopsy (2015 to 2017). Clinical characteristics and prognostic biomarkers were evaluated as predictors of prostate cancer detection by type of biopsy guidance (fused versus non-fused).

One-hundred twenty-one patients had non-fused and 90 had fused biopsies. PHI and PHID had greater area under the receiver operating characteristics curve (AUC) in predicting positive biopsies than PSA or PSAD for both non-fused and fused biopsy. PHI 0.78 (95% CI 0.67 to 0.88) and PHID 0.82 (95% CI 0.73 to 0.91) had the greatest AUC for predicting biopsy results for non-fused and fused biopsies, respectively. Multiple-variable models did not improve model fit compared to single variables. Based on Youden's index, a cut-off value of 45.9 for PHI in non-fused and 0.64 for PHID in fused biopsies would reduce the number of negative biopsies by 77.3% and 63.4%, respectively, but the percentage of missed clinically significant cancer biopsies would be 19% and 12%, respectively.

Our findings demonstrate that the choice of prognostic biomarkers for predicting positive biopsies is a function of the biopsy guidance method. Volume indexed derivatives appear to have greater value when a MRI-US fused method is used.

Urology. 2019 Mar 26 [Epub ahead of print]

Camila Lopes Vendrami, Robert J McCarthy, Argha Chatterjee, David Casalino, Edward M Schaeffer, William J Catalona, Frank H Miller

Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611. Electronic address: ., Department of Anesthesiology, Rush University, Chicago, IL 60612. Electronic address: ., Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611. Electronic address: ., Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611. Electronic address: ., Department of Urology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611. Electronic address: ., Department of Urology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611. Electronic address: ., Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611. Electronic address: .

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