PURPOSE: To evaluate the ability of the prostate health index to discern aggressive prostate cancer from indolent or no cancer on a biopsy-naïve population.
MATERIAL AND METHODS: Two independent prospective cohorts of 561 and 395 subjects with no prior prostate biopsy and enrolled at different clinical sites were used for validation of the results. We compared the diagnostic specificity of the prostate health index to pre-biopsy total PSA and percent free PSA using prostate biopsy results and determined the optimal threshold of the prostate health index to discern aggressive prostate cancer (Gleason 7 or worse) from indolent or no prostate cancer (Gleason 6 or less).
RESULTS: In the primary cohort, higher prostate health index values were significantly associated with Gleason 7 score or worse, and AUC for detection of aggressive prostate cancer was 0.815. At 95% sensitivity the prostate health index specificity was 36.0% versus 17.2% and 19.4% for total PSA and percent free PSA respectively. At 95% sensitivity in detecting aggressive prostate cancer, the optimal prostate heath index cut point was 24, which would help avoid 41% of unnecessary biopsies. A prostate health index cutoff of 24 led to 36% biopsies avoided and very few aggressive cancers missed, and these results were confirmed with the validation cohort.
CONCLUSIONS: The prostate health index detects aggressive prostate cancer with a better specificity than total PSA and percent free PSA in a biopsy-naïve population, and could be a useful tool to decrease unnecessary prostate biopsies.
de la Calle C, Patil D, Wei JT, Scherr DS, Sokoll L, Chan DW, Siddiqui J, Mosquera JM, Rubin MA, Sanda MG. Are you the author?
Emory University School of Medicine Department of Urology; University of Michigan Medical School Department of Urology, Weill Cornell Medical College; Department of Urology, Weill Cornell Medical College and NewYork Presbyterian; Johns Hopkins University School of Medicine Department of Pathology; Department of Pathology, Weill Cornell Medical College and NewYork Presbyterian; Institute for Precision Medicine; Department of Pathology, Weill Cornell Medical College and NewYork Presbyterian; Institute for Precision Medicine.
Reference: J Urol. 2015 Jan 27. pii: S0022-5347(15)00183-4.