Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection

BackgroundProstate-specific antigen (PSA) is considered neither sensitive nor specific for prostate cancer (PCa). We aimed to compare total PSA (tPSA), percentage of free PSA (%fPSA), the PSA density (PSAD), Prostate Health Index (PHI), and the PHI density (PHID) to see which one could best predict...

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Autores principales:	Shih-Ting Chiu, Yung-Ting Cheng, Yeong-Shiau Pu, Yu-Chuan Lu, Jian-Hua Hong, Shiu-Dong Chung, Chih-Hung Chiang, Chao-Yuan Huang
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	prostate health index density risk table clinically significant prostate cancer save unnecessary prostate biopsy predict lethal disease Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/cc094ae95a1545c3bc7e2bc67bde2c85
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spelling	oai:doaj.org-article:cc094ae95a1545c3bc7e2bc67bde2c852021-11-19T07:51:10ZProstate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection2234-943X10.3389/fonc.2021.772182https://doaj.org/article/cc094ae95a1545c3bc7e2bc67bde2c852021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fonc.2021.772182/fullhttps://doaj.org/toc/2234-943XBackgroundProstate-specific antigen (PSA) is considered neither sensitive nor specific for prostate cancer (PCa). We aimed to compare total PSA (tPSA), percentage of free PSA (%fPSA), the PSA density (PSAD), Prostate Health Index (PHI), and the PHI density (PHID) to see which one could best predict clinically significant prostate cancer (csPCa): a potentially lethal disease.MethodsA total of 412 men with PSA of 2–20 ng/mL were prospectively included. Serum biomarkers for PCa was collected before transrectal ultrasound guided prostate biopsy. PHI was calculated by the formula: (p2PSA/fPSA) x √tPSA. PHID was calculated as PHI divided by prostate volume measured by transrectal ultrasound.ResultsOf the 412 men, 134 (32.5%) and 94(22.8%) were diagnosed with PCa and csPCa, respectively. We used the area under the receiver operating characteristic curve (AUC) and decision curve analyses (DCA) to compare the performance of PSA related parameters, PHI and PHID in diagnosing csPCa. AUC for tPSA, %fPSA, %p2PSA, PSAD, PHI and PHID were 0.56、0.63、0.76、0.74、0.77 and 0.82 respectively for csPCa detection. In the univariate analysis, the prostate volume, tPSA, %fPSA, %p2PSA, PHI, PSAD, and PHID were all significantly associated with csPCa, and PHID was the most important predictor (OR 1.41, 95% CI 1.15–1.72). Besides, The AUC of PHID was significantly larger than PHI in csPCa diagnosis (p=0.004). At 90% sensitivity, PHID had the highest specificity (54.1%) for csPCa and could reduce the most unnecessary biopsies (43.7%) and miss the fewest csPCa (8.5%) when PHID ≥ 0.67. In addition to AUC, DCA re-confirmed the clinical benefit of PHID over all PSA-related parameters and PHI in csPCa diagnosis. The PHID cut-off value was positively correlated with the csPCa ratio in the PHID risk table, which is useful for evaluating csPCa risk in a clinical setting.ConclusionThe PHID is an excellent predictor of csPCa. The PHID risk table may be used in standard clinical practice to pre-select men at the highest risk of harboring csPCa.Shih-Ting ChiuYung-Ting ChengYeong-Shiau PuYu-Chuan LuJian-Hua HongShiu-Dong ChungShiu-Dong ChungChih-Hung ChiangChih-Hung ChiangChih-Hung ChiangChao-Yuan HuangFrontiers Media S.A.articleprostate health index densityrisk tableclinically significant prostate cancersave unnecessary prostate biopsypredict lethal diseaseNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENFrontiers in Oncology, Vol 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	prostate health index density risk table clinically significant prostate cancer save unnecessary prostate biopsy predict lethal disease Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	prostate health index density risk table clinically significant prostate cancer save unnecessary prostate biopsy predict lethal disease Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Shih-Ting Chiu Yung-Ting Cheng Yeong-Shiau Pu Yu-Chuan Lu Jian-Hua Hong Shiu-Dong Chung Shiu-Dong Chung Chih-Hung Chiang Chih-Hung Chiang Chih-Hung Chiang Chao-Yuan Huang Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection
description	BackgroundProstate-specific antigen (PSA) is considered neither sensitive nor specific for prostate cancer (PCa). We aimed to compare total PSA (tPSA), percentage of free PSA (%fPSA), the PSA density (PSAD), Prostate Health Index (PHI), and the PHI density (PHID) to see which one could best predict clinically significant prostate cancer (csPCa): a potentially lethal disease.MethodsA total of 412 men with PSA of 2–20 ng/mL were prospectively included. Serum biomarkers for PCa was collected before transrectal ultrasound guided prostate biopsy. PHI was calculated by the formula: (p2PSA/fPSA) x √tPSA. PHID was calculated as PHI divided by prostate volume measured by transrectal ultrasound.ResultsOf the 412 men, 134 (32.5%) and 94(22.8%) were diagnosed with PCa and csPCa, respectively. We used the area under the receiver operating characteristic curve (AUC) and decision curve analyses (DCA) to compare the performance of PSA related parameters, PHI and PHID in diagnosing csPCa. AUC for tPSA, %fPSA, %p2PSA, PSAD, PHI and PHID were 0.56、0.63、0.76、0.74、0.77 and 0.82 respectively for csPCa detection. In the univariate analysis, the prostate volume, tPSA, %fPSA, %p2PSA, PHI, PSAD, and PHID were all significantly associated with csPCa, and PHID was the most important predictor (OR 1.41, 95% CI 1.15–1.72). Besides, The AUC of PHID was significantly larger than PHI in csPCa diagnosis (p=0.004). At 90% sensitivity, PHID had the highest specificity (54.1%) for csPCa and could reduce the most unnecessary biopsies (43.7%) and miss the fewest csPCa (8.5%) when PHID ≥ 0.67. In addition to AUC, DCA re-confirmed the clinical benefit of PHID over all PSA-related parameters and PHI in csPCa diagnosis. The PHID cut-off value was positively correlated with the csPCa ratio in the PHID risk table, which is useful for evaluating csPCa risk in a clinical setting.ConclusionThe PHID is an excellent predictor of csPCa. The PHID risk table may be used in standard clinical practice to pre-select men at the highest risk of harboring csPCa.
format	article
author	Shih-Ting Chiu Yung-Ting Cheng Yeong-Shiau Pu Yu-Chuan Lu Jian-Hua Hong Shiu-Dong Chung Shiu-Dong Chung Chih-Hung Chiang Chih-Hung Chiang Chih-Hung Chiang Chao-Yuan Huang
author_facet	Shih-Ting Chiu Yung-Ting Cheng Yeong-Shiau Pu Yu-Chuan Lu Jian-Hua Hong Shiu-Dong Chung Shiu-Dong Chung Chih-Hung Chiang Chih-Hung Chiang Chih-Hung Chiang Chao-Yuan Huang
author_sort	Shih-Ting Chiu
title	Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection
title_short	Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection
title_full	Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection
title_fullStr	Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection
title_full_unstemmed	Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection
title_sort	prostate health index density outperforms prostate health index in clinically significant prostate cancer detection
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/cc094ae95a1545c3bc7e2bc67bde2c85
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Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection

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