A Multicentre Evaluation of the Role of the Prostate Health Index (PHI) in Regions with Differing Prevalence of Prostate Cancer: Adjustment of PHI Reference Ranges is Needed for European and Asian Settings(Figure presented.)
Journal
European Urology
Journal Volume
75
Journal Issue
4
Pages
558-561
Date Issued
2019
Author(s)
Chiu P.K.-F.
Ng C.-F.
Semjonow A.
Zhu Y.
Vincendeau S.
Houlgatte A.
Lazzeri M.
Guazzoni G.
Stephan C.
Haese A.
Bruijne I.
Teoh J.Y.-C.
Leung C.H.
Casale P.
Chiang C.H.
Tan L.G.-L.
Chiong E.
Wu H.C.
Nieboer D.
Ye D.-W.
Bangma C.H.
Roobol M.J.
Abstract
Asians have a lower incidence of prostate cancer (PC). We compared the performance of the Prostate Health Index (PHI) for 2488 men in different ethnic groups (1688 Asian and 800 European men from 9 sites) with PSA 2–20 ng/ml and PHI test and transrectal ultrasound-guided biopsy results available. Of these, 1652 men had PSA 2–10 ng/ml and a normal digital rectal examination and underwent initial biopsy. The proportions of PC (Gleason ?6) and higher-grade PC (HGPC, Gleason ?7) across different PHI ranges were compared. The performance of PSA and PHI was compared using the area under the receiver operating characteristic curve (AUC) and decision curve analyses (DCA). Among Asian men, HGPC would be diagnosed in 1.0%, 1.9%, 13%, and 30% of men using PHI thresholds of <25, 25–35, 35–55, and >55, respectively. At 90% sensitivity for HGPC (PHI >30), 56% of biopsies and 33% of Gleason 6 PC diagnoses could have been avoided. Among European men, HGPC would be diagnosed in 4.1%, 4.3%, 30%, and 34% of men using PHI thresholds of <25, 25–35, 35–55, and >55, respectively. At 90% sensitivity for HGPC (PHI >40), 40% of biopsies and 31% of Gleason 6 PC diagnoses could have been avoided. AUC and DCA confirmed the benefit of PHI over PSA. The benefit of PHI was also seen at repeat biopsy (n = 397) and for PSA 10–20 ng/ml (n = 439). PHI is effective in cancer risk stratification for both European and Asian men. However, population-specific PHI reference ranges should be used. Patient summary: The Prostate Health Index (PHI) blood test helps to identify individuals at higher risk of prostate cancer among Asian and European men, and could significantly reduce unnecessary biopsies and overdiagnosis of prostate cancer. Different PHI reference ranges should be used for different ethnic groups. The Prostate Health Index (PHI) test is effective in cancer risk stratification for both European and Asian men. A higher proportion of biopsies could be avoided among Asian men using PHI. An ethnic-specific reference range should be used. ? 2018 European Association of Urology
Subjects
Biopsy; Decision curve analysis; Prostate cancer; Prostate health index; [?2]pro–prostate-specific antigen
SDGs
Other Subjects
Article; Asian; cancer risk; clinical assessment tool; comparative study; digital rectal examination; ethnic group; European; evaluation study; Gleason score; human; human tissue; image guided biopsy; major clinical study; male; prevalence; priority journal; prostate biopsy; prostate cancer; prostate health index; receiver operating characteristic; reference value; sensitivity analysis; transrectal ultrasonography; Asia; Asian continental ancestry group; biopsy; blood; cancer grading; Caucasian; clinical trial; epidemiology; ethnology; Europe; health status; health status indicator; multicenter study; predictive value; prostate tumor; reproducibility; risk assessment; risk factor; kallikrein; kallikrein-related peptidase 3, human; prostate specific antigen; Asia; Asian Continental Ancestry Group; Biopsy; Digital Rectal Examination; Europe; European Continental Ancestry Group; Health Status; Health Status Indicators; Humans; Kallikreins; Male; Neoplasm Grading; Predictive Value of Tests; Prevalence; Prostate-Specific Antigen; Prostatic Neoplasms; Reference Values; Reproducibility of Results; Risk Assessment; Risk Factors
Publisher
Elsevier B.V.
Type
journal article