title: PHI and PCA3 improve the prognostic performance of PRIAS and Epstein criteria in predicting insignificant prostate cancer in men eligible for active surveillance.
abstract: OBJECTIVE
  To assess the performance of prostate health index (PHI) and prostate cancer antigen 3 (PCA3) when added to the PRIAS or Epstein criteria in predicting the presence of pathologically insignificant prostate cancer (IPCa) in patients who underwent radical prostatectomy (RP) but eligible for active surveillance (AS).
  
  
  METHODS
  An observational retrospective study was performed in 188 PCa patients treated with laparoscopic or robot-assisted RP but eligible for AS according to Epstein or PRIAS criteria. Blood and urinary specimens were collected before initial prostate biopsy for PHI and PCA3 measurements. Multivariate logistic regression analyses and decision curve analysis were carried out to identify predictors of IPCa using the updated ERSPC definition.
  
  
  RESULTS
  At the multivariate analyses, the inclusion of both PCA3 and PHI significantly increased the accuracy of the Epstein multivariate model in predicting IPCa with an increase of 17 % (AUC = 0.77) and of 32 % (AUC = 0.92), respectively. The inclusion of both PCA3 and PHI also increased the predictive accuracy of the PRIAS multivariate model with an increase of 29 % (AUC = 0.87) and of 39 % (AUC = 0.97), respectively. DCA revealed that the multivariable models with the addition of PHI or PCA3 showed a greater net benefit and performed better than the reference models. In a direct comparison, PHI outperformed PCA3 performance resulting in higher net benefit.
  
  
  CONCLUSIONS
  In a same cohort of patients eligible for AS, the addition of PHI and PCA3 to Epstein or PRIAS models improved their prognostic performance. PHI resulted in greater net benefit in predicting IPCa compared to PCA3.
authors.affiliation: Urology Unit, Doctorate Research Program, Magna Græcia University of Catanzaro, Viale Europa, Germaneto, Catanzaro, 88100, Italy. cantiello@unicz.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cantiello
authors.affiliation: Urology Section, Department of Surgery, University of Catania, Catania, Italy.
authors.forename: Giorgio Ivan
authors.initials: GI
authors.lastname: Russo
authors.affiliation: Urology Unit, Doctorate Research Program, Magna Græcia University of Catanzaro, Viale Europa, Germaneto, Catanzaro, 88100, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cicione
authors.affiliation: Department of Urology, European Institute of Oncology, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ferro
authors.affiliation: Urology Section, Department of Surgery, University of Catania, Catania, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Cimino
authors.affiliation: Urology Section, Department of Surgery, University of Catania, Catania, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Favilla
authors.affiliation: Department of Urology, National Cancer Institute of Naples, Naples, Italy.
authors.forename: Sisto
authors.initials: S
authors.lastname: Perdonà
authors.affiliation: Department of Urology, European Institute of Oncology, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: De Cobelli
authors.affiliation: Department of Urology, University of Messina, Messina, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Magno
authors.affiliation: Urology Section, Department of Surgery, University of Catania, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Morgia
authors.affiliation: Urology Unit, Doctorate Research Program, Magna Græcia University of Catanzaro, Viale Europa, Germaneto, Catanzaro, 88100, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Damiano
mesh_terms: D000368:Aged; D000951:Antigens, Neoplasm / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000601:surgery; D012372:ROC Curve; D012189:Retrospective Studies; D018426:SEER Program
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; C479341:prostate cancer antigen 3, human
keywords: Active surveillance; PCA3; PHI; Prognostic accuracy; Prostate cancer; Radical prostatectomy