Prostate Health Index density aids the diagnosis of prostate cancer detected using magnetic resonance imaging targeted prostate biopsy in Taiwanese multicenter study

Author:

Chang Ching-Hsin1234,Yu Ping-Hsuan4567,Hsieh Po-Fan489,Hong Jian-Hua41011,Chiang Chih-Hung41012,Cheng Hao-Min1314151617,Wu Hsi-Chin48918,Huang Chao-Yuan410,Lin Tzu-Ping4567

Affiliation:

1. Institute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC

2. Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan, ROC

3. TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan, ROC

4. Taiwan Prostate Cancer Collaboration Group

5. Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

6. Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC

7. Shu-Tien Urological Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC

8. Department of Urology, China Medical University Hospital, Taichung, Taiwan, ROC

9. School of Medicine, China Medical University, Taichung, Taiwan, ROC

10. Department of Urology, National Taiwan University Hospital, Taipei, Taiwan, ROC

11. Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, ROC

12. Division of Urology, Department of Surgery, and Department of Research and Development, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan, ROC

13. Ph.D. Program of Interdisciplinary Medicine (PIM), National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC

14. Division of Faculty Development, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

15. Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

16. Institute of Public Health, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC

17. Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC

18. Department of Urology, China Medical University Beigang Hospital, Beigang, Yunlin, Taiwan, ROC

Abstract

Background: Multiparametric magnetic resonance imaging (mpMRI) followed by MRI-targeted prostate biopsy is the current standard for diagnosing prostate cancer (PCa). However, studies evaluating the value of biomarkers, including prostate health index (PHI) and its derivatives using this method are limited. We aimed to investigate the efficacy of PHI density (PHID) in guiding MRI-targeted prostate biopsies to identify clinically significant prostate cancers (csPCa). Methods: The multicenter prospectively registered prostate biopsy database from three medical centers in Taiwan included patients with PHI and MRI targeted and/or systematic prostate biopsies. We assessed the required values of prostate-specific antigen (PSA), prostate volume, PHI, PHID, and Prostate Imaging Reporting & Data System (PI-RADS) score using multivariable analyses, receiver operating characteristic curve analysis, and decision curve analyses (DCA). csPCa was defined as the International Society of Urological Pathology Gleason group ≥2 PCa, with an emphasis on reducing unwarranted biopsies. Results: The study cohort comprised 420 individuals. Diagnoses of PCa and csPCa were confirmed in 62.4% and 47.9% of the participants, respectively. The csPCa diagnosis rates were increased with increasing PI-RADS scores (20.5%, 44.2%, and 73.1% for scores 3, 4, and 5, respectively). Independent predictors for csPCa detection included PHI, prostate volume, and PI-RADS scores of 4 and 5 in multivariable analyses. The area under the curve (AUC) for csPCa of PHID (0.815) or PHI (0.788) was superior to that of PSA density (0.746) and PSA (0.635) in the entire cohort, and the superiority of PHID (0.758) was observed in PI-RADS 3 lesions. DCA revealed that PHID achieved the best net clinical benefit in PI-RADS 3-5 and 4/5 cases. Among PI-RADS 3 lesions, cutoff values of PHID 0.70 and 0.43 could eliminate 51.8% and 30.4% of omitted biopsies, respectively. Conclusion: PHI-derived biomarkers, including PHID, performed better than other PSA-derived biomarkers in diagnosing PCa in MRI detected lesions.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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