Prostate health index density improves detection of clinically-significant prostate cancer.

To explore the utility of prostate health index (PHI) density for detection of clinically-significant prostate cancer (PCa) in a contemporary cohort of men presenting for diagnostic workup of PCa.

The study cohort included patients with elevated PSA (>2 ng/ml) and negative digital rectal examination who underwent PHI testing and prostate biopsy at our institution in 2015. Serum markers were prospectively measured per standard clinical pathway. PHI was calculated as [([-2]proPSA/free PSA) x (PSA)(½) ], and density calculations were performed using prostate volume as determined on transrectal ultrasound. Logistic regression was used to assess the ability of serum markers to predict clinically-significant PCa, defined as any Gleason score ≥7 cancer or Gleason score 6 cancer in >2 cores or >50% of any positive core.

Of 118 men with PHI testing who underwent biopsy, 47 (39.8%) were found to have clinically-significant PCa on biopsy. The median PHI density was 0.70 (IQR 0.43-1.21); it was 0.53 (IQR 0.36-0.75) in men with negative biopsy or clinically-insignificant PCa and 1.21 (IQR 0.74-1.88) in men with clinically-significant PCa (p<0.001). Clinically-significant PCa was detected in 3.6% of men in the first quartile of PHI density (<0.43), 36.7% of men in the interquartile range (0.43-1.21) of PHI density, and 80.0% of men with PHI density >1.21 (p<0.001). Using a threshold of 0.43, PHI density was 97.9% sensitive and 38.0% specific for clinically-significant PCa, and 100% sensitive for Gleason score ≥7 disease. Compared to PSA (AUC 0.52), PSAD (AUC 0.70), %free PSA (AUC 0.75), the product of %free PSA and prostate volume (AUC 0.79), and PHI (AUC 0.76), PHI density demonstrated the highest discriminative ability for clinically-significant PCa (AUC 0.84).

Based on this prospective single-center experience, PHI density could be used to avoid 38% of unnecessary biopsies while failing to detect only 2% of clinically-significant cancers. This article is protected by copyright. All rights reserved.

BJU international. 2017 Jan 06 [Epub ahead of print]

Jeffrey J Tosoian, Sasha C Druskin, Darian Andreas, Patrick Mullane, Meera Chappidi, Sarah Joo, Kamyar Ghabili, Mufaddal Mamawala, Joseph Agostino, Ballentine H Carter, Alan W Partin, Lori J Sokoll, Ashley E Ross

The James Buchanan Brady Urological Institute and Department of Urology, the Johns Hopkins University School of Medicine.

E-Newsletters

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.

Subscribe