Presentation Authors: Yung Ting Cheng*, Shih Ting Chiu, Chih-Hung Chiang, Chung-Hsin Chen, Yeong-Shiau Pu, Jian-Hua Hong, Yu-Chuang Lu, Yi-Kai Chang, Shih-Ping Liu, Shih-Chun Hung, Hong-Chiang Chang, Po-Ming Chow, Kuo-How Huang, Yuan-Ju Lee, Chao-Yuan Huang, Taipei City, Taiwan
Introduction: Prostate health index (PHI) is a promising biomarker in the prediction of aggressive prostate cancer. Since prostate volume has been regarded as an important factor contributing to elevated prostate-specific antigen (PSA), PSA density is widely used to predict the presence of prostate cancer. We aim to assess the additional efficacy of PHI density (PHID) in predicting prostate cancer in men undergoing transrectal ultrasound-guided prostate biopsy (TRUSP biopsy).
Methods: We prospectively enrolled 505 men who underwent TRUSP biopsy for suspected prostate cancer. Total PSA, free PSA, p2PSA levels were measured by serum samples before the prostate biopsy. PHI was calculated as ((p2PSA/fPSA) Ã— âˆštPSA). PHID was calculated by diving PHI by the prostate volume. Receiver operating characteristic curve (ROC curve) and multivariable logistic regression analyses were used to predict the risk of cancer detection and clinically significant prostate cancer.
Results: The detection rate of prostate cancer was 33.1% (167/505). 65.8% (110/167) of the cancer patients were found to have Gleason score 7 or higher disease. Prostate volume, total PSA, free PSA, p2PSA, p2PSA%, and PHI in cancer cases were significantly higher than the non-cancer patients. The median PHI in both cancer and non-cancer men were 50.93 and 29.79, respectively; whereas the PHID were 1.61 and 0.58, respectively. PHID had the highest area under the ROC curve (AUC) in predicting the presence of prostate cancer and clinically significant cancer than other predictors (0.806 and 0.865, both p < 0.001). At a threshold of 0.71, PHID had a sensitivity of 91.7% and a specificity 59.3% for clinically significant cancer. In multivariable logistic regression, age, prostate volume, total PSA and PHID were significant predictors of clinically significant cancer.
Conclusions: Utilizing prostate volume adds discriminative value to PHI in predicting clinical significant prostate cancer. Unnecessary biopsies could be avoided by using PHID as an alternative to PSA test.