Usefulness of the prostate health index in predicting the presence and aggressiveness of prostate cancer among Korean men: a prospective observational study

• Published in: BMC urology 2021-09, Vol.21 (1), p.131-131, Article 131
• Main Authors: Kim, Jae Yoon, Yu, Ji Hyeong, Sung, Luck Hee, Cho, Dae Yeon, Kim, Hyun-Jung, Yoo, Soo Jin
• Format: Article
• Language: English
• Subjects: Accuracy; Age groups; Aged; Asians; Biomarkers; Biopsy; Cancer; Humans; Image-Guided Biopsy; Instrument industry; Korean; Logistic Models; Male; Neoplasm Grading; Observational studies; Oncology, Experimental; Population; Prospective Studies; Prostate cancer; Prostate health index; Prostate-specific antigen; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - ethnology; Prostatic Neoplasms - pathology; Regression analysis; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Software; Urology
• ISSN: 1471-2490; 1471-2490
• DOI: 10.1186/s12894-021-00897-2

We aimed to evaluate the usefulness of the Beckman Coulter prostate health index (PHI) and to compare it with total prostate-specific antigen (PSA) levels and related derivatives in predicting the presence and aggressiveness of prostate cancer (PCa) in the Korean population. A total of 140 men who underwent their first prostate biopsy for suspected PCa were included in this prospective observational study. The diagnostic performance of total PSA, free PSA, %free PSA, [-2] proPSA (p2PSA), %p2PSA, and PHI in detecting and predicting the aggressiveness of PCa was estimated using the receiver operating characteristic curve (ROC) and logistic multivariate regression analyses. Of 140 patients, PCa was detected in 63 (45%) of participants, and 48 (76.2%) of them had significant cancer with a Gleason score (GS) ≥ 7. In the whole group, the area under the curve (AUC) for ROC analysis of tPSA, free PSA, %fPSA, p2PSA, %p2PSA, and PHI were 0.63, 0.57, 0.69, 0.69, 0.72, and 0.76, respectively, and the AUC was significantly greater in the PHI group than in the tPSA group (p = 0.005). For PCa with GS ≥ 7, the AUCs for tPSA, free PSA, %fPSA, p2PSA, %p2PSA, and PHI were 0.62, 0.58, 0.41, 0.79, 0.86, and 0.87, respectively, and the AUC was significantly greater in the PHI group than in the tPSA group (p  33.4, 22.9% (32/140) of biopsies could be avoided without missing any cases of aggressive cancer. This study shows that %p2PSA and PHI are superior to total PSA and %fPSA in predicting the presence and aggressiveness (GS ≥ 7) of PCa among Korean men. Using PHI, a significant proportion of unnecessary biopsies can be avoided.