Index of Prostate Health as a Predictive Biomarker of Biopsy Outcome
As demonstrated by Spanish authors in their work published at the beginning of 2018, the Prostate Health Index (PHI) is a biomarker that can refine the prediction of prostate biopsy outcomes in men with elevated prostate-specific antigen (PSA) levels.
Study Methodology
The level of p2PSA (one of the precursors of PSA) in the blood, along with the total PSA and free PSA levels, serves to calculate the PHI. The importance of including this parameter in the diagnosis of prostate cancer was evaluated in a prospective observational study. A total of 172 men with PSA levels of 2–10 ng/ml were included; they underwent measurements of p2PSA and free PSA with PHI calculation, followed by prostate biopsy.
Results
Prostate cancer was diagnosed in 42% of the included men. Of these, 46% were high-grade tumors. The best ability to predict biopsy outcomes (presence/absence of cancer) was found with PHI. Its predictive accuracy was at least 17% higher than other parameters. All predictive models that included PHI showed more accurate results. According to the analysis, at a probability threshold of 40%, 82 prostate biopsies could be avoided, with only 16 cancer cases and 5 high-grade tumors going undetected.
Conclusion
As the authors of this work summarize, PHI is a beneficial predictive biomarker that allows for more precise decision-making regarding the necessity of prostate biopsy in men with elevated PSA in clinical practice. This justifies the measurement of p2PSA in clinical decision-making for the diagnosis and treatment of prostate cancer.
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Source: Sanchis-Bonet A., Barrionuevo-González M., Bajo-Chueca A. et al. Does [-2]pro-prostate specific antigen meet the criteria to justify its inclusion in the clinical decision-making process? Urol Int 2018; 100 (2): 146–154, doi: 10.1159/000481439.
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