Added value of PHI in predicting lymph node invasion in prostate cancer: an external validation

Area of Science:

• Urology
• Oncology
• Medical Diagnostics

Background:

• Accurate prediction of lymph node invasion (pN1) is crucial for staging and treatment planning in prostate cancer.
• Existing nomograms like Briganti 2017 and MSKCC have limitations in predictive accuracy.
• The Prostate Health Index (PHI) is an emerging biomarker for prostate cancer assessment.

Purpose of the Study:

• To evaluate the predictive performance of Briganti 2017 and MSKCC nomograms for lymph node invasion.
• To assess the added value of Prostate Health Index (PHI) to these nomograms in a Chinese cohort.
• To validate these predictive models in patients undergoing robot-assisted radical prostatectomy with extended pelvic lymph node dissection.

Main Methods:

• Retrospective analysis of 473 Chinese prostate cancer patients undergoing robot-assisted radical prostatectomy and extended pelvic lymph node dissection.
• Validation of Briganti 2017 and MSKCC nomograms.
• Incorporation of Prostate Health Index (PHI) as a continuous variable.
• Assessment of model performance using AUC, calibration plots, and decision curve analysis.

Main Results:

• The Briganti 2017 and MSKCC nomograms showed acceptable predictive performance (AUCs 0.69 and 0.71).
• Incorporation of PHI significantly improved the predictive accuracy of both nomograms (AUCs to 0.787 and 0.782).
• PHI expanded the range of positive net benefit for clinical decision-making.

Conclusions:

• Briganti 2017 and MSKCC nomograms are acceptable for predicting pN1 in Chinese prostate cancer patients.
• Prostate Health Index (PHI) significantly enhances the discriminatory ability and clinical utility of these nomograms.
• PHI is a valuable preoperative biomarker for predicting pN1 in prostate cancer.