Diagnostic performance of Prostate Health Index (PHI) in predicting prostate cancer on prostate biopsy; a single center study

Krstev, Toni and Stojanoski, Ivica and Ilievski, Lazar and Tufekchioski, Nehrim and Stojceva-Taneva, Olivera and Trojacanec, Jasmina and Volkanovska Ilijevska, Cvetanka (2023) Diagnostic performance of Prostate Health Index (PHI) in predicting prostate cancer on prostate biopsy; a single center study. Journal of Morphological Sciences, 6 (3). pp. 222-233. ISSN 2545-4706

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Abstract

The Prostate Health Index (PHI) is a new test combining total, free and (-2)proPSA into a single
score. It was recently approved by the FDA and is now commercially available in the U.S., Europe and
Australia. Our aim is to investigate whether PHI improves specificity for detecting clinically significant
prostate cancer and can help to reduce prostate cancer biopsies.
We examined 100 men age 50 years or older with prostate specific antigen 4 to 10 ng/ml („gray
zone„) and normal digital rectal examination with suspected prostate cancer who had undergone biopsies
and were divided into a benign and malignant group. In this population we compared the performance of
prostate specific antigen, % free prostate specific antigen, (-2)proPSA and PHI to predict biopsy results
and, specifically, the presence of clinically significant prostate cancer using multiple criteria.
We found statistically significantly increased levels of −2proPSA, PHI and PSA and decreased
levels of %freePSA in patients diagnosed with prostate cancer by prostate biopsy vs. patients with benign
prostatic conditions (median values: −2proPSA: 28.3 vs. 20.11 ng/l, PHI: 73.04 vs. 30.5, total PSA: 7.3 vs.
6.48 ng/ml and %free PSA: 17.06 vs. 25.62%). On receiver operating characteristic analysis PHI had the
highest AUC for overall prostate cancer (AUCs PHI 0.954, percent free prostate specific antigen 0.345, (-
2)proPSA 0.753 and prostate specific antigen 0.656). The optimal cut-off for PHI in the study population
was 42.8 with sensitivity of 85.7% (95% CI: 54.8-90.6) and specificity of 86.1% (CI 95%, 0.913-0.995).
Whereas, in the tPSA for cut-off 6.54 sensitivity is 61.9 and specificity 59.5, respectively. The Prostate
Health Index was significantly higher in men with Gleason 7 or greater. In our study for the PHI levels (36-
54.99) only 23.08% of patients had Gleason score ≥ 7.In patients with PHI levels >55, 76.92% of patients
had Gleason score ≥ 7.
The new PHI test outperforms its individual components of total, free and (-2)proPSA for the
identification of clinically significant prostate cancer. PHI may be useful as part of a multivariable approach
to reduce prostate biopsies and overdiagnosis.
Keywords: PHI; prostate cancer, early detection, prostate biopsy.

Item Type:	Article
Subjects:	Medical and Health Sciences > Clinical medicine
Divisions:	Faculty of Medical Science
Depositing User:	Ivica Stojanoski
Date Deposited:	20 Feb 2024 12:42
Last Modified:	20 Feb 2024 12:42
URI:	https://eprints.ugd.edu.mk/id/eprint/33677

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