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. 2024 Jan 1;26(1):20-24.
doi: 10.4103/aja202332. Epub 2023 Aug 22.

Prostate health index can stratify patients with Prostate Imaging Reporting and Data System score 3 lesions on magnetic resonance imaging to reduce prostate biopsies

John Shung-Lai Leung  1   2 , Wai-Kit Ma  2 , Brian Sze-Ho Ho  1 , Stacia Tsun-Tsun Chun  1 , Rong Na  1 , Yongle Zhan  1 , Chi-Yuen Ng  2 , Chi-Ho Ip  2 , Ada Tsui-Lin Ng  1 , Yiu-Chung Lam  2
Affiliations

Prostate health index can stratify patients with Prostate Imaging Reporting and Data System score 3 lesions on magnetic resonance imaging to reduce prostate biopsies

John Shung-Lai Leung et al. Asian J Androl. .

Abstract

We aim to evaluate prostate health index as an additional risk-stratification tool in patients with Prostate Imaging Reporting and Data System score 3 lesions on multiparametric magnetic resonance imaging. Men with biochemical or clinical suspicion of having prostate cancer who underwent multiparametric magnetic resonance imaging in two tertiary centers (Queen Mary Hospital and Princess Margaret Hospital, Hong Kong, China) between January 2017 and June 2022 were included. Ultrasound-magnetic resonance imaging fusion biopsies were performed after prostate health index testing. Those who only had Prostate Imaging Reporting and Data System score 3 lesions were further stratified into four prostate health index risk groups and the cancer detection rates were analyzed. Out of the 747 patients, 47.3% had Prostate Imaging Reporting and Data System score 3 lesions only. The detection rate of clinically significant prostate cancer in this group was 15.0%. The cancer detection rates of clinically significant prostate cancer had statistically significant differences 5.3% in prostate health index <25.0, 7.4% in prostate health index 25.0-34.9, 17.9% in prostate health index 35.0-54.9, and 52.6% in prostate health index ≥55.0 (P < 0.01). Among the patients, 26.9% could have avoided a biopsy with a prostate health index <25.0, at the expense of a 5.3% risk of missing clinically significant prostate cancer. Prostate health index could be used as an additional risk stratification tool for patients with Prostate Imaging Reporting and Data System score 3 lesions. Biopsies could be avoided in patients with low prostate health index, with a small risk of missing clinically significant prostate cancer.

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Conflict of interest statement

All authors declare no competing interests.

Supplementary Information is linked to the online version of the paper on the Asian Journal of Andrology website.

Figures

Figure 1
Figure 1
Flow diagram of the patient cohort. PSA: prostate-specific antigen; DRE: digital rectal examination; mpMRI: multiparametric magnetic resonance imaging; PI-RADS: Prostate Imaging Reporting and Data System.
Figure 2
Figure 2
ROC curves of PHI, PHID, PSAD, and PSA for PI-RADS score 3 lesion patients. ROC: receiver operating characteristic; PHI: prostate health index; PSA: prostate-specific antigen; PI-RADS: Prostate Imaging Reporting and Data System; PSAD: prostate-specific antigen density; PHID: prostate health index density.
See this image and copyright information in PMC

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