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Rius Bilbao L, Valladares Gomez C, Aguirre Larracoechea U, Pereira Arias JG, Arredondo Calvo P, Urdaneta Salegui LF, Escobal Tamayo V, Sanz Jaka JP, Recio Ayesa A, Mar Medina J, Mar Medina C. Do PHI and PHI density improve detection of clinically significant prostate cancer only in the PSA gray zone? Clin Chim Acta 2023; 542:117270. [PMID: 36893880 DOI: 10.1016/j.cca.2023.117270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES Prostate health index (PHI) is a predictive biomarker of positive prostate biopsy. The majority of evidence refers to its use in the PSA gray zone (4-10 ng/mL) and negative digital rectal exam (DRE). We aim to evaluate and compare the predictive accuracy of PHI and PHI density (PHId) with PSA, percentage of free PSA and PSA density, in a wider range of patients for the detection of clinically significant prostate cancer (csPCa). METHODS Multicenter prospective study that included patients suspicious of harboring prostate cancer. Non-probabilistic convenience sampling, where men who attended the urology consultation were tested for PHI before prostate biopsy. To evaluate and compare diagnostic accuracy AUC and decision curve analysis (DCA) were calculated. All these procedures were performed for the overall sample and the following subsamples: PSA < 4 ng/ml; PSA 4-10 ng/ml; PSA 4-10 ng/ml plus negative DRE and PSA > 10 ng/ml. RESULTS Among the 559 men included, 194 (34.7%) were diagnosed of csPCa. PHI and PHId outperfomed PSA in all subgroups. PHI best diagnostic performance was found in PSA 4-10 ng/ml with negative DRE (sensitivity 93.33, NPV 96.04). Regarding AUC, significant differences were found between PHId and PSA in the subgroup of PSA 4-10 ng/ml, whatever DRE status. In DCA, PHI density shows the highest net benefit. CONCLUSIONS PHI and PHId outperfom PSA in csPCa detection, not only in the PSA grey zone with negative DRE, but also in a wider range of PSA values. There is an urgent need of prospective studies to established a validated threshold and its incorporation in risk calculators.
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Affiliation(s)
- Leire Rius Bilbao
- Osakidetza Basque Health Service, Barrualde-Galdakao Integrated Health Organisation, Department of Urology, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.
| | - Carmen Valladares Gomez
- Osakidetza Basque Health Service, Barrualde-Galdakao Integrated Health Organisation, Department of Clinical Laboratory Medicine, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Urko Aguirre Larracoechea
- Osakidetza Basque Health Service, Barrualde-Galdakao Integrated Health Organisation, Research Unit, Spain
| | | | - Pablo Arredondo Calvo
- Osakidetza Basque Health Service, Barrualde-Galdakao Integrated Health Organisation, Department of Urology, Spain
| | | | - Victor Escobal Tamayo
- Osakidetza Basque Health Service, Barakaldo-Sestao Integrated Health Organisation, Department of Urology, Spain
| | - Juan Pablo Sanz Jaka
- Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Department of Urology, Spain
| | - Adrian Recio Ayesa
- Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Department of Urology, Spain
| | - Javier Mar Medina
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Research Unit, Spain; Biodonostia Health Research Institute, Donostia-San Sebastián, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | - Carmen Mar Medina
- Osakidetza Basque Health Service, Barrualde-Galdakao Integrated Health Organisation, Department of Clinical Laboratory Medicine, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
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Ferro M, Crocetto F, Bruzzese D, Imbriaco M, Fusco F, Longo N, Napolitano L, La Civita E, Cennamo M, Liotti A, Lecce M, Russo G, Insabato L, Imbimbo C, Terracciano D. Prostate Health Index and Multiparametric MRI: Partners in Crime Fighting Overdiagnosis and Overtreatment in Prostate Cancer. Cancers (Basel) 2021; 13:cancers13184723. [PMID: 34572950 PMCID: PMC8466029 DOI: 10.3390/cancers13184723] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 12/01/2022] Open
Abstract
Simple Summary In the last decades, the widespread use of PSA as the standard tool for prostate cancer diagnosis led to a high rate of overdiagnosis and overtreatment. More recently, multiparametric magnetic resonance imaging (mpMRI) became part of the diagnostic pathway, and several next-generation PSA-based tests (PHI, PHI density, 4Kscore, STHLM3) have been proposed. The multivariable approach promises to help with a better stratification of PCa patients at initial diagnosis. In this study, we evaluated the performance of the prostate health index (PHI) and mpMRI for the prediction of positive biopsy and of high-grade PCa at radical prostatectomy (RP). Our findings suggested that PHI had a better ability than mpMRI to predict positive biopsy, whereas a comparable performance in the identification of pathological aggressive PCa was pointed out. Notably, PHI and PHI density might represent useful biomarkers to recognize high-grade PCa in patients with low or uncertain PI-RADS scores on mpMRI. Abstract Widespread use of PSA as the standard tool for prostate cancer (PCa) diagnosis led to a high rate of overdiagnosis and overtreatment. In this study, we evaluated the performance of the prostate health index (PHI) and multiparametric magnetic resonance imaging (mpMRI) for the prediction of positive biopsy and of high-grade PCa at radical prostatectomy (RP). To this end, we prospectively enrolled 196 biopsy-naïve patients who underwent mpMRI. A subgroup of 116 subjects with biopsy-proven PCa underwent surgery. We found that PHI significantly outperformed both PI-RADS score (difference in AUC: 0.14; p < 0.001) and PHI density (difference in AUC: 0.08; p = 0.002) in the ability to predict positive biopsy with a cut-off value of 42.7 as the best threshold. Conversely, comparing the performance in the identification of clinically significant prostate cancer (csPCa) at RP, we found that PHI ≥ 61.68 and PI-RADS score ≥ 4 were able to identify csPCa (Gleason score ≥ 7 (3 + 4)) both alone and added to a base model including age, PSA, fPSA-to-tPSA ratio and prostate volume. In conclusion, PHI had a better ability than PI-RADS score to predict positive biopsy, whereas it had a comparable performance in the identification of pathological csPCa.
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Affiliation(s)
- Matteo Ferro
- Division of Urology, European Institute of Oncology (IEO), IRCCS, 20141 Milan, Italy;
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.C.); (N.L.); (L.N.); (C.I.)
| | - Dario Bruzzese
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (D.B.); (G.R.)
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.I.); (L.I.)
| | - Ferdinando Fusco
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.C.); (N.L.); (L.N.); (C.I.)
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.C.); (N.L.); (L.N.); (C.I.)
| | - Evelina La Civita
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (E.L.C.); (M.C.); (A.L.); (M.L.)
| | - Michele Cennamo
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (E.L.C.); (M.C.); (A.L.); (M.L.)
| | - Antonietta Liotti
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (E.L.C.); (M.C.); (A.L.); (M.L.)
| | - Manuela Lecce
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (E.L.C.); (M.C.); (A.L.); (M.L.)
| | - Gianluca Russo
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (D.B.); (G.R.)
| | - Luigi Insabato
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.I.); (L.I.)
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.C.); (N.L.); (L.N.); (C.I.)
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (E.L.C.); (M.C.); (A.L.); (M.L.)
- Correspondence: ; Tel.: +39-8-1746-2038
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