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Related Experiment Video

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Combining Serum Prostate Health Index With Urinary PCA3 and TMPRSS2:ERG RNA Testing Improves Detection of Clinically

Nicholas W Eyrich1, Yijian Huang2, Yingye Zheng3

  • 1Department of Urology, Emory University School of Medicine, Atlanta, Georgia.

JU Open Plus
|February 19, 2026
PubMed
Summary

Combining prostate health index (Phi) with prostate cancer antigen 3 (PCA3) and TMPRSS2:ERG (T2:ERG) improves prostate biopsy selection. This combination enhances early detection of aggressive prostate cancer (PCa).

Keywords:
PSAbiomarkersbiopsyprostate cancer

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Area of Science:

  • Urology
  • Oncology
  • Biomarker Research

Background:

  • Prostate cancer (PCa) detection relies on accurate risk stratification.
  • Existing biomarkers like prostate health index (Phi), prostate cancer antigen 3 (PCA3), and TMPRSS2:ERG (T2:ERG) show promise individually.
  • The combined diagnostic utility of these biomarkers for PCa detection has not been fully explored.

Purpose of the Study:

  • To evaluate if combining Phi with urinary PCA3 and T2:ERG improves the selection of men for prostate biopsy.
  • To develop and validate clinical algorithms integrating these biomarkers for predicting aggressive PCa (Grade Group ≥ 2).

Main Methods:

  • A training cohort (N=512) and a validation cohort (N=561) of men undergoing prostate biopsy were used.
  • Serum Phi and urine PCA3-T2:ERG levels were assayed.
  • Clinical algorithms were developed and validated to predict PCa outcomes.

Main Results:

  • The combination of Phi and urinary PCA3 significantly outperformed Phi alone in predicting PCa.
  • Serum Phi combined with urinary PCA3-T2:ERG demonstrated superior performance compared to urinary PCA3-T2:ERG alone across three distinct clinical workflows.
  • Statistical significance (P values < .05) was achieved in all validation comparisons.

Conclusions:

  • Combining serum Phi with urinary PCA3 RNA, with or without T2:ERG RNA, enhances the selection of men for initial prostate biopsy.
  • This integrated biomarker approach offers a promising strategy for improving the early detection of aggressive prostate cancer.