ORIGINAL ARTICLE
Year : 2016  |  Volume : 18  |  Issue : 4  |  Page : 633-638

Performance of the Prostate Health Index in predicting prostate biopsy outcomes among men with a negative digital rectal examination and transrectal ultrasonography


1 Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai; Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
2 Department of Urology, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
3 Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
4 Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China; Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
5 State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China
6 Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
7 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
8 State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China; Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
9 Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina; Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
10 Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China; Department of Urology, Huashan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China; Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA

Correspondence Address:
Dr. Jianfeng Xu
Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China; Department of Urology, Huashan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China; Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA

Dr. Qiang Ding
Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai; Department of Urology, Huashan Hospital, Fudan University, Shanghai
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1008-682X.172823

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The [-2]proPSA (p2PSA) and its derivatives, the p2PSA-to-free PSA ratio (%p2PSA), and the Prostate Health Index (PHI) have greatly improved discrimination between men with and without prostate cancer (PCa) in prostate biopsies. However, little is known about their performance in cases where a digital rectal examination (DRE) and transrectal ultrasonography (TRUS) are negative. A prospective cohort of 261 consecutive patients in China with negative DRE and TRUS were recruited and underwent prostate biopsies. A serum sample had collected before the biopsy was used to measure various PSA derivatives, including total prostate-specific antigen (tPSA), free PSA, and p2PSA. For each patient, the free-to-total PSA ratio (%fPSA), PSA density (PSAD), p2PSA-to-free PSA ratio (%p2PSA), and PHI were calculated. Discriminative performance was assessed using the area under the receiver operating characteristic curve (AUC) and the biopsy rate at 91% sensitivity. The AUC scores within the entire cohort with respect to age, tPSA, %fPSA, PSAD, p2PSA, %p2PSA, and PHI were 0.598, 0.751, 0.646, 0.789, 0.814, 0.808, and 0.853, respectively. PHI was the best predictor of prostate biopsy results, especially in patients with a tPSA of 10.1-20 ng ml−1 . Compared with other markers, at a sensitivity of 91%, PHI was the most useful for determining which men did not need to undergo biopsy, thereby avoiding unnecessary procedures. The use of PHI could improve the accuracy of PCa detection by predicting prostate biopsy outcomes among men with a negative DRE and TRUS in China.


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