Prediction of Cancer Aggressiveness: Prostate Health Index (PHI) as a Promising Future Marker
The Prostate Health Index (PHI) is a diagnostic blood test that combines the levels of prostate-specific antigen (PSA), free PSA (fPSA), and the isoform [-2]proPSA (p2PSA). Its use in prostate cancer diagnostics can reduce the number of unnecessary prostate biopsies compared to determining PSA alone. A recently published Czech study assessed the utility of PHI in evaluating the aggressiveness of prostate cancer. The study compared PHI values with the results of preoperative biopsy and postoperative prostate histology in men indicated for radical prostatectomy.
Method and Study Progress
The study included men who underwent prostate biopsy and subsequent radical prostatectomy between July 2013 and June 2016, and whose preoperative levels of PSA, fPSA, and p2PSA were determined. Gleason scores (GS) were determined from both preoperative biopsy and postoperative histological examination. Patients were divided into groups with GS 6 and GS ≥ 7, based on biopsy results and postoperative histology. In both cases, PSA, p2PSA, %fPSA, and PHI values were compared between the groups with GS 6 and GS ≥ 7.
Results
Samples from 474 men, with an average age of 67 years (range 43–76 years), were analyzed.
According to preoperative biopsy, 297 men had GS 6, and 177 men had GS ≥ 7. Statistically significant differences in PSA (p = 0.0012), p2PSA (p < 0.0001), and PHI (p < 0.0001) levels were found between these groups.
According to postoperative histological examination, 181 men had GS 6, and 293 men had GS ≥ 7. Statistically significant differences were found in all parameters: PSA (p = 0.0012), p2PSA (p < 0.0001), %fPSA (p < 0.0001), and PHI (p < 0.0001) between these groups.
The best sensitivity-specificity ratio (largest area under the curve) for predicting GS 6 or GS ≥ 7 was found for PHI, based on both biopsy and histology results.
Conclusion
The authors conclude that among the observed parameters, PHI is the best modality for categorizing patients into GS 6 and GS ≥ 7 categories. Its use may assist in decision-making between monitoring and performing a radical prostatectomy, or between a more conservative and a more radical surgical approach.
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Source: Brož P., Dolejšová O., Fuchsová R., et al. Prostate Health Index in Comparison with Biopsy and Postoperative Histology in Predicting Prostate Cancer. Clinical Biochemistry and Metabolism 2019; 27 (1): 9–15.
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