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Volume 24, Issue 4 (July 2022) 24, 406–410; 10.4103/aja202174

Prostate Health Index (phi) and its derivatives predict Gleason score upgrading after radical prostatectomy among patients with low-risk prostate cancer

Jia-Qi Yan1, Da Huang1, Jing-Yi Huang1, Xiao-Hao Ruan1, Xiao-Ling Lin2, Zu-Jun Fang2, Yi Gao1, Hao-Wen Jiang2, Yi-Shuo Wu2, Rong Na1, Dan-Feng Xu1

1 Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
2 Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China

Correspondence: Dr. R Na (narong.hs@gmail.com) or Dr. YS Wu (ys_wu1@126.com)

Date of Submission 20-Jun-2021 Date of Acceptance 12-Sep-2021 Date of Web Publication 12-Nov-2021


To analyze the performance of the Prostate Health Index (phi) and its derivatives for predicting Gleason score (GS) upgrading between prostate biopsy and radical prostatectomy (RP) in the Chinese population, an observational, prospective RP cohort consisting of 351 patients from two medical centers was established from January 2017 to September 2020. Pathological reclassification was determined by the Gleason Grade Group (GG). The area under the receiver operating characteristic curve (AUC) and logistic regression (LR) models were used to evaluate the predictive performance of predictors. In clinically low-risk patients with biopsy GG ≤2, phi (odds ratio [OR] = 1.80, 95% confidence interval [95% CI]: 1.14–2.82, P = 0.01) and its derivative phi density (PHID; OR = 2.34, 95% CI: 1.30–4.20, P = 0.005) were significantly associated with upgrading to GG ≥3 after RP, and the results were confirmed by multivariable analysis. Similar results were observed in patients with biopsy GG of 1 for the prediction of upgrading to RP GG ≥2. Compared to the base model (AUC = 0.59), addition of the phi or PHID could provide additional predictive value for GS upgrading in low-risk patients (AUC = 0.69 and 0.71, respectively, both P < 0.05). In conclusion, phi and PHID could predict GS upgrading after RP in clinically low-risk patients.

Keywords: Gleason score; prostate biopsy; prostate cancer; Prostate Health Index; radical prostatectomy; upgrading

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