Utility of Combining Prostate Health Index and Magnetic Resonance Imaging for the Diagnosis of Prostate Cancer

In this study, we compared the prostate health index (PHI) and the Prostate Imaging Reporting and Data System (PI-RADS) before prostate biopsy and evaluated the utility of combining them in the diagnosis of prostate cancer (PC).

Between November 2021 and March 2023, 105 patients admitted to Gunma University Hospital for prostate biopsy after undergoing both MRI and PHI measurements were enrolled in this study. We investigated the diagnostic impacts of [-2]proPSA related indexes on clinically significant PC (csPC) and the complementary effects of PHI and PI-RADS.

The median of PHI was 59.9, and 72 patients (69%) were diagnosed with PC. The receiver operating characteristic (ROC) curve for patients diagnosed with PC indicated an area under the curve (AUC) of 0.816 for PHI and 0.753 for PI-RADS. For PHI, when the sensitivity was 90% and 95%, the specificity was 51.5% and 45.5%, respectively. Both are higher than those of the conventional PSA-related indices. In addition, the ROC curve in patients with a diagnosis of csPC (n = 67) indicated an AUC of 0.793 for PHI and 0.746 for PI-RADS. Furthermore, if biopsy was restricted to patients with PI-RADS ≥ 4 or PHI ≥ 38.1, 21% of unnecessary biopsies could be avoided, with only one (1.5%) patient with csPC being missed.

PHI is more available for detecting csPC than PSA and PSA F/T. Moreover, there is a possibility that unnecessary prostate biopsies can be avoided by combining PHI and PI-RADS.