title: Prostate Health Index (Phi) and Prostate Cancer Antigen 3 (PCA3) significantly improve prostate cancer detection at initial biopsy in a total PSA range of 2-10 ng/ml.
abstract: Many efforts to reduce prostate specific antigen (PSA) overdiagnosis and overtreatment have been made. To this aim, Prostate Health Index (Phi) and Prostate Cancer Antigen 3 (PCA3) have been proposed as new more specific biomarkers. We evaluated the ability of phi and PCA3 to identify prostate cancer (PCa) at initial prostate biopsy in men with total PSA range of 2-10 ng/ml. The performance of phi and PCA3 were evaluated in 300 patients undergoing first prostate biopsy. ROC curve analyses tested the accuracy (AUC) of phi and PCA3 in predicting PCa. Decision curve analyses (DCA) were used to compare the clinical benefit of the two biomarkers. We found that the AUC value of phi (0.77) was comparable to those of %p2PSA (0.76) and PCA3 (0.73) with no significant differences in pairwise comparison (%p2PSA vs phi p = 0.673, %p2PSA vs. PCA3 p = 0.417 and phi vs. PCA3 p = 0.247). These three biomarkers significantly outperformed fPSA (AUC = 0.60), % fPSA (AUC = 0.62) and p2PSA (AUC = 0.63). At DCA, phi and PCA3 exhibited a very close net benefit profile until the threshold probability of 25%, then phi index showed higher net benefit than PCA3. Multivariable analysis showed that the addition of phi and PCA3 to the base multivariable model (age, PSA, %fPSA, DRE, prostate volume) increased predictive accuracy, whereas no model improved single biomarker performance. Finally we showed that subjects with active surveillance (AS) compatible cancer had significantly lower phi and PCA3 values (p<0.001 and p = 0.01, respectively). In conclusion, both phi and PCA3 comparably increase the accuracy in predicting the presence of PCa in total PSA range 2-10 ng/ml at initial biopsy, outperforming currently used %fPSA.
authors.affiliation: Urology Unit, University Federico II, Naples, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ferro
authors.forename: Dario
authors.initials: D
authors.lastname: Bruzzese
authors.forename: Sisto
authors.initials: S
authors.lastname: Perdonà
authors.forename: Ada
authors.initials: A
authors.lastname: Marino
authors.forename: Claudia
authors.initials: C
authors.lastname: Mazzarella
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Perruolo
authors.forename: Vittoria
authors.initials: V
authors.lastname: D'Esposito
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cosimato
authors.forename: Carlo
authors.initials: C
authors.lastname: Buonerba
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Lorenzo
authors.forename: Gennaro
authors.initials: G
authors.lastname: Musi
authors.forename: Ottavio
authors.initials: O
authors.lastname: De Cobelli
authors.forename: Felix K
authors.initials: FK
authors.lastname: Chun
authors.forename: Daniela
authors.initials: D
authors.lastname: Terracciano
mesh_terms: D000368:Aged; D000951:Antigens, Neoplasm / Q000097:blood / Q000235:genetics*; D019540:Area Under Curve; D014408:Biomarkers, Tumor / Q000097:blood / Q000235:genetics*; D001706:Biopsy; D042241:Early Diagnosis; D015870:Gene Expression; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011467:Prostate / Q000378:metabolism* / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood / Q000235:genetics*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D012372:ROC Curve; D012107:Research Design
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; C479341:prostate cancer antigen 3, human; D017430:Prostate-Specific Antigen