PHI Density Prospectively Improves Prostate Cancer Detection - Beyond the Abstract

Our investigation in a large prospective cohort of 1057 biopsied men showed a significantly larger area under the ROC curve (AUC) for Prostate Health Index (PHI) density (PHID) in comparison with PHI alone. In this well-balanced group with 552 men with prostate cancer (PCa) and 505 without PCa from two tertiary centers in Germany the AUC for PHID was 0.835 and for PHI 0.801 (p=0.0013).

The decision curve analysis (DCA) had a small maximum net benefit of ~5% for PHID versus PHI between 35% and 65% threshold probability. In the WHO-calibrated PSA grey-zone up to 8 ng/ml (former up to 10 ng/ml grey-zone with Hybritech calibration), PHID was also significantly better than PHI (AUC 0.819 vs. 0.789; p=0.0219) but the absolute AUC difference in those ~700 patients was less than 0.03. However, PHID was not different from PHI in the detection of significant PCa with a Gleason score of ≥7. This non-superiority of PHID versus PHI in detecting significant PCa was seen in all subgroups with different prostate volume cutoffs and PSA ranges. This shows, on the other hand, the excellent discriminatory power of PHI independently from prostate volume.

While several earlier studies between 2014 and 2020 with an average of fewer than 200 patients (range n= 112 to n=275) found an advantage for PHID in comparison with PHI, a recent study reported PHID not to be able to outperform PHI for predicting any or clinically significant PCa in either cohort of 595 or 1025 Asian men.1 This discrepancy might be solved in additional studies with large numbers of > 1000 patients to draw a (hopefully) final conclusion if PHID is clinically more useful than PHI alone in detecting significant PCa.

Written by: Carsten Stephan & Klaus Jung, Department of Urology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Germany


  1. Huang D, Wu YS, Ye DW, Qi J, Liu F, Helfand BT, Zheng SL, Ding Q, Xu DF, Na R, Xu JF, Sun YH (2020) Prostate volume does not provide additional predictive value to prostate health index for prostate cancer or clinically significant prostate cancer: results from a multicenter study in China. Asian J Androl 22:539–543

Read the Abstract