Skip to main content
SpringerLink
Log in

The predictive value of the prostate health index vs. multiparametric magnetic resonance imaging for prostate cancer diagnosis in prostate biopsy

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To compare the ability of Prostate Health Index (PHI) to diagnose csPCa, with that of total PSA, PSA density (PSAD) and the multiparametric magnetic resonance (mpMRI) of the prostate.

Methods

We analysed a group of 395 men planned for a prostate biopsy who underwent a mpMRI of the prostate evaluated using the PIRADS v1 criteria. All patients had their PHI measured before prostate biopsy. In patients with an mpMRI suspicious lesions, an mpMRI/ultrasound software fusion-guided biopsy was performed first, with 12 core systematic biopsy performed in all patients. A ROC analysis was performed for PCa detection for total PSA, PSAD, PIRADS score and PHI; with an AUC curve calculated for all criteria and a combination of PIRADS score and PHI. Subsequent sub-analyses included patients undergoing first and repeat biopsy.

Results

The AUC for predicting the presence of csPCa in all patients was 59.5 for total PSA, 69.7 for PHI, 64.9 for PSAD and 62.5 for PIRADS. In biopsy naive patients it was 61.6 for total PSA, 68.9 for PHI, 64.6 for PSAD and 63.1 for PIRADS. In patients with previous negative biopsy the AUC for total PSA, PHI, PSAD and PIRADS was 55.4, 71.2, 64.4 and 69.3, respectively. Adding of PHI to PIRADS increased significantly (p = 0.007) the accuracy for prediction of csPCa.

Conclusion

Prostate Health Index could serve as a tool in predicting csPCa. When compared to the mpMRI, it shows comparable results. The PHI cannot, however, help us guide prostate biopsies in any way, and its main use may, therefore, be in pre-MRI or pre-biopsy triage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Mottet N, van den Bergh RCN, Briers E et al (2018) EAU - ESTRO - ESUR - SIOG Guidelines on Prostate Cancer 2018. In: European Association of Urology Guidelines, 2018th edn. European Association of Urology Guidelines Office, Arnhem, The Netherlands

    Google Scholar 

  2. Shariat SF, Roehrborn CG (2008) Using biopsy to detect prostate cancer. Rev Urol 10:262–280

    PubMed  PubMed Central  Google Scholar 

  3. Shaw GL, Thomas BC, Dawson SN et al (2014) Identification of pathologically insignificant prostate cancer is not accurate in unscreened men. Br J Cancer 110:2405–2411. https://doi.org/10.1038/bjc.2014.192

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Thompson JE, van Leeuwen PJ, Moses D et al (2016) The diagnostic performance of multiparametric magnetic resonance imaging to detect significant prostate cancer. J Urol 195:1428–1435. https://doi.org/10.1016/j.juro.2015.10.140

    Article  CAS  PubMed  Google Scholar 

  5. Ahmed HU, El-Shater Bosaily A, Brown LC et al (2017) Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 389:815–822. https://doi.org/10.1016/S0140-6736(16)32401-1

    Article  PubMed  Google Scholar 

  6. Loeb S, Catalona WJ (2014) The Prostate Health index: a new test for the detection of prostate cancer. Ther Adv Urol 6:74–77. https://doi.org/10.1177/1756287213513488

    Article  PubMed  PubMed Central  Google Scholar 

  7. Barentsz JO, Richenberg J, Clements R et al (2012) ESUR prostate MR guidelines 2012. Eur Radiol 22:746–757. https://doi.org/10.1007/s00330-011-2377-y

    Article  PubMed  PubMed Central  Google Scholar 

  8. Le BV, Griffin CR, Loeb S et al (2010) [-2]Proenzyme prostate specific antigen is more accurate than total and free prostate specific antigen in differentiating prostate cancer from benign disease in a prospective prostate cancer screening study. J Urol 183:1355–1359. https://doi.org/10.1016/j.juro.2009.12.056

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Catalona WJ, Partin AW, Sanda MG et al (2011) A Multicenter study of [-2] pro-prostate specific antigen combined with prostate specific antigen and free prostate specific antigen for prostate cancer detection in the 2.0–10.0 ng/ml prostate specific antigen range. J Urol 185:1650–1655. https://doi.org/10.1016/j.juro.2010.12.032

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Filella X, Giménez N (2013) Evaluation of [-2] proPSA and Prostate Health Index (phi) for the detection of prostate cancer: a systematic review and meta-analysis. Clin Chem Lab Med 51:729–739. https://doi.org/10.1515/cclm-2012-0410

    Article  CAS  PubMed  Google Scholar 

  11. Loeb S, Shin SS, Broyles DL et al (2017) Prostate Health Index improves multivariable risk prediction of aggressive prostate cancer. BJU Int 120:61–68. https://doi.org/10.1111/bju.13676

    Article  CAS  PubMed  Google Scholar 

  12. White J, Shenoy BV, Tutrone RF et al (2018) Clinical utility of the Prostate Health Index (phi) for biopsy decision management in a large group urology practice setting. Prostate Cancer Prostatic Dis 21:78–84. https://doi.org/10.1038/s41391-017-0008-7

    Article  PubMed  Google Scholar 

  13. Rosenkrantz AB, Ginocchio LA, Cornfeld D et al (2016) Interobserver Reproducibility of the PI-RADS Version 2 Lexicon: a multicenter study of six experienced prostate radiologists. Radiology 280:793–804. https://doi.org/10.1148/radiol.2016152542

    Article  PubMed  Google Scholar 

  14. Zhao C, Gao G, Fang D et al (2016) The efficiency of multiparametric magnetic resonance imaging (mpMRI) using PI-RADS Version 2 in the diagnosis of clinically significant prostate cancer. Clin Imaging 40:885–888. https://doi.org/10.1016/j.clinimag.2016.04.010

    Article  PubMed  Google Scholar 

  15. Druskin SC, Tosoian JJ, Young A et al (2018) Combining Prostate Health Index density, magnetic resonance imaging and prior negative biopsy status to improve the detection of clinically significant prostate cancer. BJU Int 121:619–626. https://doi.org/10.1111/bju.14098

    Article  PubMed  Google Scholar 

  16. Drost F-JH, Osses DF, Nieboer D et al (2019) Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD012663.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  17. Schoots IG, Roobol MJ, Nieboer D et al (2015) Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol 68:438–450. https://doi.org/10.1016/j.eururo.2014.11.037

    Article  PubMed  Google Scholar 

  18. Fütterer JJ, Briganti A, De Visschere P et al (2015) Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging? A systematic review of the literature. Eur Urol 68:1045–1053. https://doi.org/10.1016/j.eururo.2015.01.013

    Article  PubMed  Google Scholar 

  19. Matoso A, Epstein JI (2019) Defining clinically significant prostate cancer on the basis of pathological findings. Histopathology 74:135–145. https://doi.org/10.1111/his.13712

    Article  PubMed  Google Scholar 

  20. Shah ZK, Elias SN, Abaza R et al (2015) Performance comparison of 1.5-T endorectal coil MRI with 3.0-T nonendorectal coil MRI in patients with prostate cancer. Acad Radiol 22:467–474. https://doi.org/10.1016/j.acra.2014.11.007

    Article  PubMed  PubMed Central  Google Scholar 

  21. Park BK, Kim B, Kim CK et al (2007) Comparison of phased-array 3.0-T and endorectal 1.5-T magnetic resonance imaging in the evaluation of local staging accuracy for prostate cancer. J Comput Assist Tomogr 31:534–538. https://doi.org/10.1097/01.rct.0000250108.85799.e1

    Article  PubMed  Google Scholar 

  22. Weinreb JC, Barentsz JO, Choyke PL et al (2016) PI-RADS prostate imaging - reporting and data system: 2015, version 2. Eur Urol 69:16–40. https://doi.org/10.1016/j.eururo.2015.08.052

    Article  PubMed  Google Scholar 

  23. Auer T, Edlinger M, Bektic J et al (2017) Performance of PI-RADS version 1 versus version 2 regarding the relation with histopathological results. World J Urol 35:687–693. https://doi.org/10.1007/s00345-016-1920-5

    Article  CAS  PubMed  Google Scholar 

  24. Becker AS, Cornelius A, Reiner CS et al (2017) Direct comparison of PI-RADS version 2 and version 1 regarding interreader agreement and diagnostic accuracy for the detection of clinically significant prostate cancer. Eur J Radiol 94:58–63. https://doi.org/10.1016/j.ejrad.2017.07.016

    Article  PubMed  Google Scholar 

  25. Krishna S, McInnes M, Lim C et al (2017) Comparison of prostate imaging reporting and data system versions 1 and 2 for the detection of peripheral zone gleason Score 3 + 4 = 7 Cancers. Am J Roentgenol 209:W365–W373. https://doi.org/10.2214/AJR.17.17964

    Article  Google Scholar 

  26. Gaur S, Harmon S, Mehralivand S et al (2018) Prospective comparison of PI-RADS version 2 and qualitative in-house categorization system in detection of prostate cancer. J Magn Reson Imaging 48:1326–1335. https://doi.org/10.1002/jmri.26025

    Article  PubMed  PubMed Central  Google Scholar 

  27. Simmons LAM, Kanthabalan A, Arya M et al (2018) Accuracy of transperineal targeted prostate biopsies, visual estimation and image fusion in men needing repeat biopsy in the PICTURE trial. J Urol 200:1227–1234. https://doi.org/10.1016/j.juro.2018.07.001

    Article  PubMed  Google Scholar 

  28. Vaché T, Bratan F, Mège-Lechevallier F et al (2014) Characterization of prostate lesions as benign or malignant at multiparametric MR imaging: comparison of three scoring systems in patients treated with radical prostatectomy. Radiology 272:446–455. https://doi.org/10.1148/radiol.14131584

    Article  PubMed  Google Scholar 

Download references

Funding

Supported by the Ministry of Health of the Czech Republic, grant nr. 15-27047A.

Author information

Authors and Affiliations

  1. Department of Urology, 3rd Faculty of Medicine of Charles University and Thomayer Hospital, Vídeňská 800, Prague, 14059, Czech Republic

    Jiří Stejskal, Vanda Adamcová & Roman Zachoval

  2. 1st Faculty of Medicine, Charles University, Prague, Czech Republic

    Miroslav Záleský

  3. Department of Urology, 2nd Faculty of Medicine of Charles University, University Hospital Motol, Prague, Czech Republic

    Vojtěch Novák & Štěpán Veselý

  4. Department of Urology, 1st Faculty of Medicine of Charles university, General Universtity Hospital, Prague, Czech Republic

    Otakar Čapoun & Vojtěch Fiala

  5. Department of Urology, Faculty of Medicine in Pilsen, Charles University, University Hospital in Pilsen, Pilsen, Czech Republic

    Olga Dolejšová & Hana Sedláčková

Authors
  1. Jiří Stejskal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vanda Adamcová
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miroslav Záleský
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vojtěch Novák
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Otakar Čapoun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vojtěch Fiala
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Olga Dolejšová
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hana Sedláčková
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Štěpán Veselý
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Roman Zachoval
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors have made a significant contribution to the findings and methods in the paper. All authors have read and approved the final draft. JS: Data collection or management, Data analysis, Manuscript writing and editing, VA: Data collection or management, ZM: Data collection or management, Critical revision of the article, NV: Data collection or management, OČ: Data collection or management, Critical revision of the article, FV: Data collection or management, DO: Data collection or management, SH: Data collection or management, ŠV: Project development, Data analysis, Manuscript writing and editing, Critical revision of the article, RZ: Project development, Critical revision of the article.

Corresponding author

Correspondence to Jiří Stejskal.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This research study was conducted retrospectively from data obtained for clinical purposes. The study was performed in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Ethics Committee of Motol University Hospital approved this study.

Informed consent

All data were analysed retrospectively. Patients were informed and consented prior to both magnetic resonance imaging and prostate biopsy.

Availability of data and material

Source data are available for review.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stejskal, J., Adamcová, V., Záleský, M. et al. The predictive value of the prostate health index vs. multiparametric magnetic resonance imaging for prostate cancer diagnosis in prostate biopsy. World J Urol 39, 1889–1895 (2021). https://doi.org/10.1007/s00345-020-03397-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-020-03397-4

Keywords

Search

Navigation