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Volume 18, Issue 4 (July 2016) 18, 633–638; 10.4103/1008-682X.172823
Performance of the Prostate Health Index in predicting prostate biopsy outcomes among men with a negative digital rectal examination and transrectal ultrasonography
Guo-Peng Yu1, Rong Na1, Ding-Wei Ye2, Jun Qi3, Fang Liu4, Hai-Tao Chen5, Yi-Shuo Wu1, Gui-Ming Zhang2, Jie-Lin Sun6, Yao Zhu2, Li-Qun Huang3, Shan-Cheng Ren7, De-Ke Jiang8, S Lilly Zheng9, Hao-Wen Jiang1, Ying-Hao Sun7, Qiang Ding1, Jianfeng Xu10
1 Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai; Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
2 Department of Urology, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
3 Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
4 Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China; Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA,
5 State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China
6 Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
7 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
8 State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China; Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA,
9 Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina; Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
10 Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China; Department of Urology, Huashan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China; Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA,
Correspondence: Dr. Q Ding (dingqiang.hs@gmail.com) or Dr. J Xu (jxu8088@gmail.com)
Received: 02 June 2015; Revised: 02 August 2015; Accepted: 20 November 2015
| Abstract |
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The [-2]proPSA (p2PSA) and its derivatives, the p2PSA-to-free PSA ratio (%p2PSA), and the Prostate Health Index (PHI) have greatly improved discrimination between men with and without prostate cancer (PCa) in prostate biopsies. However, little is known about their performance in cases where a digital rectal examination (DRE) and transrectal ultrasonography (TRUS) are negative. A prospective cohort of 261 consecutive patients in China with negative DRE and TRUS were recruited and underwent prostate biopsies. A serum sample had collected before the biopsy was used to measure various PSA derivatives, including total prostate-specific antigen (tPSA), free PSA, and p2PSA. For each patient, the free-to-total PSA ratio (%fPSA), PSA density (PSAD), p2PSA-to-free PSA ratio (%p2PSA), and PHI were calculated. Discriminative performance was assessed using the area under the receiver operating characteristic curve (AUC) and the biopsy rate at 91% sensitivity. The AUC scores within the entire cohort with respect to age, tPSA, %fPSA, PSAD, p2PSA, %p2PSA, and PHI were 0.598, 0.751, 0.646, 0.789, 0.814, 0.808, and 0.853, respectively. PHI was the best predictor of prostate biopsy results, especially in patients with a tPSA of 10.1-20 ng ml−1 . Compared with other markers, at a sensitivity of 91%, PHI was the most useful for determining which men did not need to undergo biopsy, thereby avoiding unnecessary procedures. The use of PHI could improve the accuracy of PCa detection by predicting prostate biopsy outcomes among men with a negative DRE and TRUS in China.
Keywords: [-2]proPSA; prostate cancer; Prostate Health Index; prostate-specific antigen; receiver operating curve
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