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Clinical Research

Use of the Prostate Health Index for detection of prostate cancer: results from a large academic practice

Prostate Cancer and Prostatic Diseases volume 20, pages 228–233 (2017)Cite this article

Subjects

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 phi<19.6 were diagnosed with PCa, and only three men with phi<27 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 phi<27 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%; P<0.001). 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.

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Acknowledgements

AER is supported by a DOD PRTA award (W81XWH-13-1-0445) as well as a PCF Young Investigator Award and Patrick C. Walsh Investigator Grant. EMS is supported by NIH U01CA196390-01.

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Authors and Affiliations

  1. Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA

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

  2. Virginia Commonwealth University School of Medicine, Richmond, VA, USA

    D Andreas

  3. The Department of Radiology, Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    K J Macura

  4. The Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    E M Schaeffer

  5. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    L J Sokoll & A E Ross

  6. Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    L J Sokoll & A E Ross

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  1. J J Tosoian
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Correspondence to J J Tosoian.

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Tosoian, J., Druskin, S., Andreas, D. et al. Use of the Prostate Health Index for detection of prostate cancer: results from a large academic practice. Prostate Cancer Prostatic Dis 20, 228–233 (2017). https://doi.org/10.1038/pcan.2016.72

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