Introduction: The purpose of this article was to evaluate the diagnostic value of prostate health index (PHI) and its derivatives in prostate cancer (PCa) with prostate imaging reporting and data system (PI-RADS)-3 lesions. Methods: Patients with benign prostatic hyperplasia (BPH) (n = 155) were included in the BPH group, while all patients with PCa (n = 49) were enrolled in the PCa group. Between the groups, the serum concentrations of total prostate-specific antigen (TPSA), percent-free prostate-specific antigen (%fPSA), prostate health index (PHI), prostate health index density (PHID), and prostate-specific antigen density (PSAD) were compared. Results: On average, 49 (24%) of 204 men had PCa on biopsy, with 81.63% of those cases being clinically serious. Age, prostate volume, TPSA, and PSAD did not significantly differ between the PCa group and the BPH group. In contrast, [-2]pro prostate-specific antigen (p2PSA) (17.10 ± 4.77 vs. 13.93 ± 3.22, p < 0.001), PHI (33.88 ± 8.81 vs. 25.83 ± 5.63, p < 0.001), and PHID (0.52 ± 0.15 vs. 0.38 ± 0.11, p < 0.001) showed a statistically significant difference between the two groups. Compared to conventional PSA, PHI (AUC = 0.786, 95% CI: 0.705–0.867) and PHID (AUC = 0.763, 95% CI: 0.684–0.843) were considerably better predictors of all PCa. The TPSA, %fPSA, p2PSA, PHI, PHID, and PSAD areas under the receiver operating characteristic for clinically significant PCa (csPCa) were 0.587, 0.650, 0.696, 0.823, 0.796, and 0.614, respectively. Out of all the various parameters, PHI and PHID performed very well in this cohort’s biopsy outcome prediction. Conclusion: PHI offers the best diagnostic value for detecting PCa in cases of PI-RADS-3 lesions. Additionally, PHID raised the possibility of csPCa PI-RADS-3 lesions. However, more investigation is required to confirm our results by using multicenter collaboration.

1.
Hugosson
J
,
Roobol
MJ
,
Mansson
M
,
Tammela
TLJ
,
Zappa
M
,
Nelen
V
.
A 16-yr follow-up of the European randomized study of screening for prostate cancer
.
Eur Urol
.
2019 Jul
76
1
43
51
.
2.
Taitt
HE
.
Global trends and prostate cancer: a review of incidence, detection, and mortality as influenced by race, ethnicity, and geographic location
.
Am J Mens Health
.
2018 Nov 1
12
6
1807
23
.
3.
Gilbert
R
,
Tilling
K
,
Martin
RM
,
Lane
JA
,
Davis
M
,
Hamdy
FC
.
Developing new age-specific prostate-specific antigen thresholds for testing for prostate cancer
.
Cancer Causes Control
.
2018 Mar
29
3
383
8
.
4.
Thompson
IM
,
Goodman
PJ
,
Tangen
CM
,
Lucia
MS
,
Miller
GJ
,
Ford
LG
.
The influence of finasteride on the development of prostate cancer
.
N Engl J Med
.
2003 Jul 17
349
3
215
24
.
5.
Placer
J
,
Planas
J
,
Celma
A
,
Morote
J
.
[Current role of protatic specific antigen (PSA) and its by-products in the diagnosis of prostate cancer]
.
Arch Esp Urol
.
2015 Apr
68
3
210
28
.
6.
Huang
D
,
Yang
X
,
Wu
Y
,
Lin
X
,
Xu
D
,
Na
R
.
Cost-effectiveness analysis of prostate health index in decision making for initial prostate biopsy
.
Front Oncol
.
2020
;
10
:
565382
.
7.
Novak
V
,
Vesely
S
,
Luksanová
H
,
Prusa
R
,
Capoun
O
,
Fiala
V
.
Preoperative prostate health index predicts adverse pathology and Gleason score upgrading after radical prostatectomy for prostate cancer
.
BMC Urol
.
2020 Sep 7
20
1
144
.
8.
Cai
GH
,
Yang
QH
,
Chen
WB
,
Liu
QY
,
Zeng
YR
,
Zeng
YJ
.
Diagnostic performance of PI-RADS v2, proposed adjusted PI-RADS v2 and biparametric magnetic resonance imaging for prostate cancer detection: a preliminary study
.
Curr Oncol
.
2021 Jun
28
3
1823
34
.
9.
Druskin
SC
,
Tosoian
JJ
,
Young
A
,
Collica
S
,
Srivastava
A
,
Ghabili
K
.
Combining Prostate Health Index density, magnetic resonance imaging and prior negative biopsy status to improve the detection of clinically significant prostate cancer
.
Bju Int
.
2018 Apr
121
4
619
26
.
10.
Tan
L
,
Tan
Y
,
Tai
B
,
Tan
K
,
Gauhar
V
,
Tiong
H
.
Prospective validation of %p2PSA and the prostate health index, in prostate cancer detection in initial prostate biopsies of Asian men, with total PSA 4-10 ng ml -1
.
Asian J Androl
.
2017
;
19
(
3
):
286
.
11.
Stephan
C
,
Jung
K
,
Lein
M
,
Rochow
H
,
Friedersdorff
F
,
Maxeiner
A
.
PHI density prospectively improves prostate cancer detection
.
World J Urol
.
2021 Jan 20
39
9
3273
9
.
12.
White
J
,
Shenoy
B
,
Tutrone
R
,
Karsh
L
,
Saltzstein
D
,
Harmon
W
.
Clinical utility of the Prostate Health Index (phi) for biopsy decision management in a large group urology practice setting
.
Prostate Cancer Prostatic Dis
.
2018
;
21
(
1
):
78
84
.
13.
Faiena
I
,
Salmasi
A
,
Mendhiratta
N
,
Markovic
D
,
Ahuja
P
,
Hsu
W
.
PI-RADS version 2 category on 3 tesla multiparametric prostate magnetic resonance imaging predicts oncologic outcomes in Gleason 3 + 4 prostate cancer on biopsy
.
J Urol
.
2019 Jan
201
1
91
7
.
14.
Yang
S
,
Zhao
W
,
Tan
S
,
Zhang
Y
,
Wei
C
,
Chen
T
.
Combining clinical and MRI data to manage PI-RADS 3 lesions and reduce excessive biopsy
.
Transl Androl Urol
.
2020 Jun
9
3
1252
61
.
15.
Hectors
SJ
,
Chen
C
,
Chen
J
,
Wang
J
,
Gordon
S
,
Yu
M
.
Magnetic resonance imaging radiomics-based machine learning prediction of clinically significant prostate cancer in equivocal PI-RADS 3 lesions
.
J Magn Reson Imaging
.
2021 Nov
54
5
1466
73
.
16.
Tosoian
JJ
,
Druskin
SC
,
Andreas
D
,
Mullane
P
,
Chappidi
M
,
Joo
S
.
Prostate Health Index density improves detection of clinically significant prostate cancer
.
Bju Int
.
2017 Dec
120
6
793
8
.
17.
Barisiene
M
,
Bakavicius
A
,
Stanciute
D
,
Jurkeviciene
J
,
Zelvys
A
,
Ulys
A
.
Prostate health index and prostate health index density as diagnostic tools for improved prostate cancer detection
.
BioMed Res Int
.
2020 Jul 22
2020
9872146
.
18.
Huang
D
,
Wu
YS
,
Ye
DW
,
Qi
J
,
Liu
F
,
Helfand
BT
.
Prostate volume does not provide additional predictive value to prostate health index for prostate cancer or clinically significant prostate cancer: results from a multicenter study in China
.
Asian J Androl
.
2020 Oct
22
5
539
43
.
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