Use of the prostate health index for detection of prostate cancer: Results from a large academic practice

J. J. Tosoian, S. C. Druskin, D. Andreas, P. Mullane, M. Chappidi, S. Joo, K. Ghabili, J. Agostino, K. J. Macura, H. B. Carter, E. M. Schaeffer, A. W. Partin, L. J. Sokoll, A. E. Ross

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: The Prostate Health Index (phi) outperforms PSA and other PSA derivatives for the diagnosis of prostate cancer (PCa). The impact of phi testing in the real-world clinical setting has not been previously assessed. METHODS: In a single, large, academic center, phi was tested in 345 patients presenting for diagnostic evaluation for PCa. Findings on prostate biopsy (including Grade Group (GG), defined as GG1: Gleason score (GS) 6, GG2: GS 3+4 = 7, GG3: GS 4+3 = 7, GG4: GS 8 and GG5: GS 9-10), magnetic resonance imaging (MRI) and radical prostatectomy (RP) were prospectively recorded. Biopsy rates and outcomes were compared with a contemporary cohort that did not undergo phi testing (n = 1318). RESULTS: Overall, 39% of men with phi testing underwent prostate biopsy. No men with phio19.6 were diagnosed with PCa, and only three men with phio27 had cancer of GG> 2. Phi was superior to PSA for the prediction of any PCa (area under the receiver operating characteristic curve (AUC) 0.72 vs 0.47) and GG >2 PCa (AUC 0.77 vs 0.53) on prostate biopsy. Among men undergoing MRI and phi, no men with phio27 and PI-RADS< 3 had GG >2 cancer. For those men proceeding to RP, increasing phi was associated with higher pathologic GG (P = 0.002) and stage (P = 0.001). Compared with patients who did not undergo phi testing, the use of phi was associated with a 9% reduction in the rate of prostate biopsy (39% vs 48%; Po0.001). Importantly, the reduction in biopsy among the phi population was secondary to decreased incidence of negative (8%) and GG1 (1%) biopsies, whereas the proportion of biopsies detecting GG> 2 cancers remained unchanged. CONCLUSIONS: In this large, real-Time clinical experience, phi outperformed PSA alone, was associated with high-grade PCa, and provided complementary information to MRI. Incorporation of phi into clinical practice reduced the rate of unnecessary biopsies without changing the frequency of detection of higher-grade cancers.

Original languageEnglish (US)
Pages (from-to)228-233
Number of pages6
JournalProstate Cancer and Prostatic Diseases
Volume20
Issue number2
DOIs
StatePublished - Jun 1 2017

ASJC Scopus subject areas

  • Oncology
  • Urology
  • Cancer Research

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