The Prostate Health Index aids multi-parametric MRI in diagnosing significant prostate cancer

• Published in: Scientific reports Vol. 11; no. 1; p. 1286
• Main Authors: Fan, Yu-Hua, Pan, Po-Hsun, Cheng, Wei-Ming, Wang, Hsin-Kai, Shen, Shu-Huei, Liu, Hsian-Tzu, Cheng, Hao-Min, Chen, Wei-Ren, Huang, Tzu-Hao, Wei, Tzu-Chun, Huang, I-Shen, Lin, Chih-Chieh, Huang, Eric Y. H., Chung, Hsiao-Jen, Huang, William J. S., Lin, Tzu-Ping
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 05-03-2021; Nature Publishing Group; Nature Portfolio
• Subjects: 692/4025; 692/4028; 692/53; Biomarkers; Biopsy; Humanities and Social Sciences; Lesions; Magnetic resonance imaging; multidisciplinary; Performance evaluation; Prostate cancer; Science; Science (multidisciplinary); Ultrasound
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-78428-6

To evaluate the performance of the Prostate Health Index (PHI) in magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion prostate biopsy for the detection of clinically significant prostate cancer (csPCa). We prospectively enrolled 164 patients with at least one Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) ≥ 3 lesions who underwent MRI-TRUS fusion prostate biopsy. Of the PSA-derived biomarkers, the PHI had the best performance in predicting csPCa (AUC 0.792, CI 0.707–0.877) in patients with PI-RADS 4/5 lesions. Furthermore, the predictive power of PHI was even higher in the patients with PI-RADS 3 lesions (AUC 0.884, CI 0.792–0.976). To minimize missing csPCa, we used a PHI cutoff of 27 and 7.4% of patients with PI-RADS 4/5 lesions could have avoided a biopsy. At this level, 2.0% of cases with csPCa would have been missed, with sensitivity and NPV rates of 98.0% and 87.5%, respectively. However, the subgroup of PI-RADS 3 was too small to define the optimal PHI cutoff. PHI was the best PSA-derived biomarker to predict csPCa in MRI-TRUS fusion prostate biopsies in men with PI-RADS ≥ 3 lesions, especially for the patients with PI-RADS 3 lesions who gained the most value.