Combining prostate health index and mpMRI data (MRI Spectroscopy) to manage PI-RADS lesions and reduce excessive biopsy, a single center study

Krstev, Toni and Stojanoski, Ivica and Ilievski, Lazar and Tufekchioski, Nerhim and Prgova-Veljanova, Biljana and Kostova, Masha and Stojcheva-Taneva, Olivera and Trojacanec, Jasmina and Milenkovski, Stefan (2023) Combining prostate health index and mpMRI data (MRI Spectroscopy) to manage PI-RADS lesions and reduce excessive biopsy, a single center study. Journal of Morphological Sciences, 6 (3). pp. 203-216. ISSN 2545-4706

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Abstract

To evaluate the values of PHI and PI-RADS findings in the early detection and prediction of
prostate cancer, as well as their application in clinical trials, especially when values of PSA are in the „ grey
zone„ with negative DRE.
The 100 patients, men aged 50 years or older with prostate-specific antigen 4 to 10 ng/ml („gray zone„) and
normal digital rectal examination with suspected prostate cancer were examined, who had undergone
biopsy and were divided in two groups. A group with no evidence of PCa (non PCa) and the group with
PCa.
The performance of PHI and mpMRI PI-RADS score was compared to predict biopsy results and,
specifically, the presence of clinically significant prostate cancer (csPCa) using multiple criteria. Among
100 subjects, 21 (21.0%) were diagnosed with PC, including 13 (61.95%) with csPC (Gleason≥7).
By the threshold of PHI≥36, the sensitivity, specificity, PPV, and NPV to predict PCa were 100%, 68.35%,
45.65%, and 100%, respectively.
The best cut-off (PHI) was 42.8% with sensitivity 85.7% and specificity 86.1%. The area under the
receiver operator characteristic curve (AUC) of combining PHI and mpMRI was greater than that of PHI
alone (0.993 vs. 0.954, p=0.002) and mpMRI alone (0.993 vs. 0.976, p=0.025).
Comparing the performance in the identification of clinically significant prostate cancer (csPCa),
we found that PHI ≥ 73.04 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.
If biopsy was restricted to patients with PI-RADS 5 as well as PI-RADS 3 or 4 and PHI≥36.0, 50%
of biopsy could be avoided with one csPCa patient being missed.
The analyzed correlation between PHI and PI-RADS score was statistically significant (p<0.0001).
According to the value of Spearman's coefficient, R=0.748, the correlation is positive, i.e. direct, and they
showed that with an increase in the value of the prostatic health index, (PHI) the PI-RADS score increases,
and vice versa.
The combination of PHI and mpMRI had higher accuracy for detection of csPC compared with
PHI or mpMRI alone.
Keywords: Prostate health index, mpMRI PI-RADS, detection of prostate cancer

Item Type:	Article
Subjects:	Medical and Health Sciences > Clinical medicine
Divisions:	Faculty of Medical Science
Depositing User:	Ivica Stojanoski
Date Deposited:	20 Feb 2024 09:28
Last Modified:	20 Feb 2024 09:28
URI:	https://eprints.ugd.edu.mk/id/eprint/33676

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