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Related Concept Videos

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Related Experiment Video

Updated: Mar 21, 2026

Detection and Isolation of Cancer in Prostate Biopsies Using Stimulated Raman Histology and Artificial Intelligence
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Clinical Validation of the Prostate Health Index for Detecting Clinically Significant Prostate Cancer in a

Hiroshi Yaegashi1,2, Kazufumi Nakashima2, Sotaro Miwa2

  • 1Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan.

International Journal of Urology : Official Journal of the Japanese Urological Association
|March 20, 2026
PubMed
Summary

The Prostate Health Index (phi) significantly improves the detection of clinically significant prostate cancer (csPC) in men within the PSA gray zone. This enhanced diagnostic performance can lead to more efficient screening and fewer unnecessary biopsies.

Keywords:
PSA gray zoneclinically significant prostate cancerdecision curve analysisfree‐to‐total PSA ratioprostate health index

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Area of Science:

  • Urology
  • Oncology
  • Diagnostic Accuracy

Background:

  • Prostate cancer screening relies on Prostate-Specific Antigen (PSA) testing.
  • The PSA "gray zone" (2.01-10.00 ng/mL) presents diagnostic challenges.
  • Distinguishing clinically significant prostate cancer (csPC) from benign conditions in this range is crucial.

Purpose of the Study:

  • To evaluate the diagnostic performance of the Prostate Health Index (phi) for csPC detection.
  • To compare phi with total PSA and the free-to-total PSA ratio (F/T ratio) in the PSA gray zone.
  • To assess the utility of phi in a population-based screening setting in Kanazawa city, Japan.

Main Methods:

  • Analysis of data from 571 men who underwent prostate biopsy within a population-based screening program (2019-2023).
  • Comparison of diagnostic accuracy using receiver operating characteristic (ROC) curves.
  • Evaluation of clinical utility via decision curve analysis (DCA).

Main Results:

  • The area under the ROC curve (AUC) for phi (0.761) was significantly higher than for the F/T ratio (0.673) and PSA (0.691).
  • Decision curve analysis indicated that phi provided the greatest net benefit for csPC detection across relevant threshold probabilities.
  • Phi demonstrated superior diagnostic performance compared to PSA and F/T ratio in the PSA gray zone.

Conclusions:

  • The Prostate Health Index (phi) offers improved discrimination for clinically significant prostate cancer in the PSA gray zone.
  • Incorporating phi into screening protocols may reduce unnecessary referrals and enhance overall screening efficiency.
  • Phi shows promise as a valuable tool for optimizing prostate cancer screening in population-based programs.