AIM: The purpose of this study was to investigate the Prostate Health Index as a marker for tumor aggressiveness in prostate biopsy and the optimization of indication for treatment options. METHODS: Our cohort consisted of 320 patients indicated for radical prostatectomy with preoperative measurements of total prostate-specific antigen, free prostate-specific antigen, [-2]proPSA, calculated %freePSA, and Prostate Health Index. The Gleason score was determined during biopsy and after radical prostatectomy. Using the Gleason score, we divided the group of patients into the 2 subgroups: Gleason score ≤6 and Gleason score >6. This division was performed according to the biopsy Gleason score and according to the postoperative Gleason score. We compared total prostate-specific antigen, [-2]proPSA, %freePSA, and Prostate Health Index in the subgroups Gleason score ≤6 and Gleason score >6 after biopsy and the definitive score. RESULTS: On evaluation of the subgroups created by Gleason score ≤6 and Gleason score >6, we observed agreement between biopsy Gleason score and definitive Gleason score in only 45.3% of cases. Of the calculated biopsy, Gleason score ≤6 and Gleason score >6 subgroups, [-2]proPSA, and Prostate Health Index ( P = .0003 and P = .0005) were statistically significant. Of the definitive Gleason score ≤6 and Gleason score >6 subgroups, Prostate Health Index, [-2]proPSA, %freePSA, and PSA ( P < .0001, P < .0001, P = .0003, and P = .0043) were statistically significant. The best area under the curve value (0.7496) was achieved by Prostate Health Index when the subgroups were established according to the postoperative Gleason score. CONCLUSION: Prostate Health Index is the best of the tested markers for the categorization of Gleason score 6 tumors and for facilitating the management of patients with prostate cancer. Prostate Health Index can be a helpful marker for indication of active surveillance or radical prostatectomy. Prostate health index can also simplify the decision of whether to perform nerve-sparing radical prostatectomy.

Department of Immunochemistry University Hospital and Faculty of Medicine in Pilsen Pilsen Czech Republic

Department of Pathology University Hospital and Faculty of Medicine in Pilsen Pilsen Czech Republic

Department of Urology University Hospital and Faculty of Medicine in Pilsen Pilsen Czech Republic

See more in PubMed

Fuchsova R, Topolcan O, Windrichova J, et al. PHI in the early detection of prostate cancer. Anticancer Res. 2015;35(9):4855–4857. PubMed

Wilt TJ, Jones KM, Barry MJ, et al. Follow-up of prostatectomy versus observation for early prostate cancer. N Enql J Med. 2017;377(2):132–142. doi:10.1056/NEJMoa1615869. PubMed

Maxeiner A, Kilic E, Matalon J, et al. The prostate health index PHI predicts oncological outcome and biochemical recurrence after radical prostatectomy—analysis in 437 patients. Oncotarget. 2017;8(45):79279–79288. doi:10.18632/oncotarget.17476. [Epub ahead of print]. PubMed PMC

Epstein JI, Egevad L, Amin MB, et al. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol. 2016;40(2):244–252. doi:10.1097/PAS.0000000000000530. PubMed

Epstein JI, Zelefsky MJ, Sjoberg DD, et al. A contemporary prostate cancer grading system: a validated alternative to the Gleason score. Eur Urol. 2016;69(3):428–435. PubMed PMC

Fossati N, Buffi NM, Haese A, et al. Preoperative prostate-specific antigen isoform p2PSA and its derivatives, %p2PSA and prostate health index, predict pathologic outcomes in patients undergoing radical prostatectomy for prostate cancer: results from a Multicentric European Prospective Study. Eur Urol. 2016;68(1):132–138. PubMed

Kulac I, Haffner MC, Yegnasubramanian S, Epstein JI, De Marzo AM. Should Gleason 6 be labeled as cancer? Curr Opin Urol. 2015;25(3):238–245. PubMed PMC

Carter HB, Partin AW, Walsh PC, et al. Gleason Score 6 adenocarcinoma: should it be labeled as cancer? J Clin Oncol. 2012;30(35):4294–4296. PubMed PMC

Pivovarcikova K, Branzovsky J, Bauleth K, et al. Radical prostatectomy—analysis of 191 cases examined using whole-mount section method. Czech Urol. 2014;18(1):26–32.

DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837–845. PubMed

Lepor A, Catalona WJ, Loeb S. The prostate health index: its utility in prostate cancer detection. Urol Clin North Am. 2016;43(1):1–6. doi:10.1016/j.ucl.2015.08.001. PubMed PMC

Sanda M, Wei J, Broyles D, et al. Evaluation of the Prostate Health Index (PHI) for improving prostate cancer detection and identification of clinically significant prostate cancer in the 4 to 10 ng/mL PSA range. In: Proceedings of American Urological Association Annual Meeting San Diego, Rev Urol. 2013;15(2).

Lazzeri M, Haese A, Abrate A, et al. Clinical performance of serum prostate-specific antigen isoform [-2]proPSA (p2PSA) and its derivatives, %p2PSA and the Prostate Health Index (PHI), in men with a family history of prostate cancer: results from a multicentre European study, the PROMETHEUS Project. BJU Int. 2013;112(3):313–321. PubMed

Wang W, Wang M, Wang L, et al. Diagnostic ability of %p2PSA and prostate health index for aggressive prostate cancer: a meta-analysis. Sci Rep. 2014;4:5012. PubMed PMC

Heidenreich A, Aus G, Bolla M, Joniau S, et al. European Association of Urology. EAU guidelines on prostate cancer. Eur Urol. 2008;53(1):68–80. PubMed

Toren P, Alibhai SM, Matthew A, et al. The effect of nerve-sparing surgery on patient-reported continence post-radical prostatectomy. Can Urol Assoc J. 2009;3(6):465–470. PubMed PMC

Friedersdorff F, Groß B, Maxeiner A, et al. Does the prostate health index depend on tumor volume?—a study on 196 patients after radical prostatectomy. Int J Mol Sci. 2017;18(3):488. PubMed PMC

Beauval JB, Cabarrou B, Gandaglia G, et al. External validation of a nomogram for identification of pathologically favorable disease in intermediate risk prostate cancer patients. Prostate. 2017;77(8):928–933. doi:10.1002/pros.23348. PubMed

Gandaglia G, Schiffmann J, Schlomm T, et al. Identification of pathologically favorable disease in intermediate-risk prostate cancer patients: implications for active surveillance candidates. Prostate. 2015;75(13):1484–1491. doi:10.1002/pros.23040. PubMed

Guazzoni G, Lazzeri M, Nava L, et al. Preoperative prostate-specific antigen isoform p2PSA and its derivatives, %p2PSA and prostate health index, predict pathologic outcomes in patients undergoing radical prostatectomy for prostate cancer. Eur Urol. 2012;61(3):455–466. PubMed

Scattoni V, Lazzeri M, Lughezzani G, et al. Head-to-head comparison of prostate health index and urinary PCA3 for predicting cancer at initial or repeat biopsy. J Urol. 2013;190(2):496–501. PubMed

Hendriks RJ, van Oort IM, Schalken JA. Blood-based and urinary prostate cancer biomarkers: a review and comparison of novel biomarkers for detection and treatment decisions. Prostate Cancer Prostatic Dis. 2017;20(1):12–19. PubMed

Lamy PJ, Allory Y, Gauchez AS, et al. Prognostic biomarkers used for localised prostate cancer management: a systematic review [published online ahead of print]. Eur Urol Focus. 2017;7(17). PubMed

National Comprehensive Cancer Network Guidelines Version 1.2018, Prostate Cancer Early Detection, National Comprehensive Cancer Network. 2018. https://www.nccn.org/.

Prostate Cancer Diagnostic Algorithm as a "Road Map" from the First Stratification of the Patient to the Final Treatment Decision

Preoperative prostate health index predicts adverse pathology and Gleason score upgrading after radical prostatectomy for prostate cancer

Prostate cancer management: long-term beliefs, epidemic developments in the early twenty-first century and 3PM dimensional solutions

Abdominal aortic aneurysm in prostate cancer patients: the "road map" from incidental detection to advanced predictive, preventive, and personalized approach utilizing common follow-up for both pathologies