Combining prostate health index and multiparametric magnetic resonance imaging in the diagnosis of clinically significant prostate cancer in an Asian population.
OBJECTIVE
To evaluate the practicability of combining prostate health index (PHI) and multiparametric magnetic resonance imaging (mpMRI) for the detection of clinically significant prostate cancer (csPC) in an Asian population.


PATIENTS AND METHODS
We prospectively enrolled patients who underwent prostate biopsy due to elevated serum prostate-specific antigen (PSA > 4 ng/mL) and/or abnormal digital rectal examination in a tertiary referral center. Before prostate biopsy, the serum samples were tested for PSA, free PSA, and p2PSA to calculate PHI. Besides, mpMRI was performed using a 3-T scanner and reported in the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2). The diagnostic performance of PHI, mpMRI, and combination of both was assessed.


RESULT
Among 102 subjects, 39 (38.2%) were diagnosed with PC, including 24 (23.5%) with csPC (Gleason ≥ 7). By the threshold of PI-RADS ≥ 3, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to predict csPC were 100%, 44.9%, 35.8%, and 100%, respectively. By the threshold of PHI ≥ 30, the sensitivity, specificity, PPV, and NPV to predict csPC were 91.7%, 43.6%, 33.3%, and 94.4%, respectively. The area under the receiver operator characteristic curve of combining PHI and mpMRI was greater than that of PHI alone (0.873 vs. 0.735, p = 0.002) and mpMRI alone (0.873 vs. 0.830, p = 0.035). If biopsy was restricted to patients with PI-RADS 5 as well as PI-RADS 3 or 4 and PHI ≥ 30, 50% of biopsy could be avoided with one csPC patient being missed.


CONCLUSION
The combination of PHI and mpMRI had higher accuracy for detection of csPC compared with PHI or mpMRI alone in an Asian population.
['Hsieh|Po-Fan|PF|', 'Li|Wei-Juan|WJ|', 'Lin|Wei-Ching|WC|', 'Chang|Han|H|', 'Chang|Chao-Hsiang|CH|', 'Huang|Chi-Ping|CP|', 'Yang|Chi-Rei|CR|', 'Chen|Wen-Chi|WC|', 'Chang|Yi-Huei|YH|', 'Wu|Hsi-Chin|HC|']
D000368:Aged D044466:Asians D001706:Biopsy D005240:Feasibility Studies D006801:Humans D007610:Kallikreins D008297:Male D008875:Middle Aged D000081364:Multiparametric Magnetic Resonance Imaging D011237:Predictive Value of Tests D011446:Prospective Studies D011467:Prostate D017430:Prostate-Specific Antigen D011471:Prostatic Neoplasms D012680:Sensitivity and Specificity
Prostate health index mpMRI PI-RADS Prostate cancer detection