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

Peter K.F. Chiu, Chi Fai Ng, Axel Semjonow, Yao Zhu, Sébastien Vincendeau, Alain Houlgatte, Massimo Lazzeri, Giorgio Ferruccio Guazzoni, Carsten Stephan, Alexander Haese, Ilse Bruijne, Jeremy Yuen Chun Teoh, Chi Ho Leung, Paolo Casale, Chih Hung Chiang, Lincoln Guan Lim Tan, Edmund Chiong, Chao Yuan Huang, Hsi Chin Wu, Daan NieboerDing Wei Ye, Chris H. Bangma, Monique J. Roobol

Research output: Contribution to journalArticle

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.

Original languageEnglish
JournalEuropean Urology
DOIs
Publication statusAccepted/In press - Jan 1 2018

Keywords

  • Biopsy
  • Decision curve analysis
  • Prostate cancer
  • Prostate health index
  • [−2]pro–prostate-specific antigen

ASJC Scopus subject areas

  • Urology

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    Chiu, P. K. F., Ng, C. F., Semjonow, A., Zhu, Y., Vincendeau, S., Houlgatte, A., Lazzeri, M., Guazzoni, G. F., Stephan, C., Haese, A., Bruijne, I., Teoh, J. Y. C., Leung, C. H., Casale, P., Chiang, C. H., Tan, L. G. L., Chiong, E., Huang, C. Y., Wu, H. C., ... Roobol, M. J. (Accepted/In press). 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. European Urology. https://doi.org/10.1016/j.eururo.2018.10.047