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A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Volume-adjusted p2PSA-derived indices for predicting prostate cancer: the PROPHET study
Masaki Shiota1, Yoshitaka Sekine2, Shoji Tokunaga3
1Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan. shiota.masaki.101@m.kyushu-u.ac.jp.
International Journal of Clinical Oncology
|June 9, 2026
Summary
Volume-adjusted prostate health index (PHI) and transition zone (TZ) volume-adjusted PHI show improved diagnostic accuracy for prostate cancer (PCa). These indices may help reduce unnecessary biopsies while maintaining high sensitivity.
Area of Science:
- Urology
- Oncology
- Diagnostic Imaging
Background:
- Prostate cancer (PCa) detection relies on accurate diagnostic tools.
- p2PSA-derived indices, adjusted for prostate or transition zone (TZ) volume, are being evaluated for enhanced PCa diagnosis.
Purpose of the Study:
- To assess the diagnostic value of volume-adjusted p2PSA-derived indices for detecting any and clinically significant prostate cancer (PCa).
- To compare the performance of these indices against traditional markers like PSA density.
Main Methods:
- Prospective multicenter study (PROPHET) involving 363 men.
- Measurement of total PSA, free PSA, and p2PSA to calculate %p2PSA, p2PSA/%fPSA, and Prostate Health Index (PHI).
- Diagnostic accuracy evaluated using ROC curve analysis, specificity, PPV, NPV, and FPR.
Main Results:
- PHI density and TZ volume-adjusted PHI demonstrated superior diagnostic performance for any PCa and clinically significant PCa (csPCa) compared to PSA density.
- These indices achieved AUCs of 0.797-0.823 with FPRs of 42.0-50.5%.
- Biopsy avoidance was possible in 49-58% of men without csPCa while maintaining 90% sensitivity.
Conclusions:
- Volume-adjusted p2PSA-derived indices, specifically PHI density and TZ volume-adjusted PHI, offer improved diagnostic performance for PCa detection.
- These validated indices show potential for reducing unnecessary prostate biopsies in clinical practice.
