Prostate health index (PHI) and prostate-specific antigen (PSA) predictive models for prostate cancer in the Chinese population and the role of digital rectal examination-estimated prostate volume

To investigate PSA- and PHI (prostate health index)-based models for prediction of prostate cancer (PCa) and the feasibility of using DRE-estimated prostate volume (DRE-PV) in the models.

This study included 569 Chinese men with PSA 4-10 ng/mL and non-suspicious DRE with transrectal ultrasound (TRUS) 10-core prostate biopsies performed between April 2008 and July 2015. DRE-PV was estimated using 3 pre-defined classes: 25, 40, or 60 ml. The performance of PSA-based and PHI-based predictive models including age, DRE-PV, and TRUS prostate volume (TRUS-PV) was analyzed using logistic regression and area under the receiver operating curves (AUC), in both the whole cohort and the screening age group of 55-75.

PCa and high-grade PCa (HGPCa) was diagnosed in 10.9 % (62/569) and 2.8 % (16/569) men, respectively. The performance of DRE-PV-based models was similar to TRUS-PV-based models. In the age group 55-75, the AUCs for PCa of PSA alone, PSA with DRE-PV and age, PHI alone, PHI with DRE-PV and age, and PHI with TRUS-PV and age were 0.54, 0.71, 0.76, 0.78, and 0.78, respectively. The corresponding AUCs for HGPCa were higher (0.60, 0.70, 0.85, 0.83, and 0.83). At 10 and 20 % risk threshold for PCa, 38.4 and 55.4 % biopsies could be avoided in the PHI-based model, respectively.

PHI had better performance over PSA-based models and could reduce unnecessary biopsies. A DRE-assessed PV can replace TRUS-assessed PV in multivariate prediction models to facilitate clinical use.

International urology and nephrology. 2016 Jun 27 [Epub ahead of print]

Peter K F Chiu, Monique J Roobol, Jeremy Y Teoh, Wai-Man Lee, Siu-Ying Yip, See-Ming Hou, Chris H Bangma, Chi-Fai Ng

Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China., Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands., Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China., Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China., Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China., Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China., Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands., Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China. .

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