title: Prostate Health Index (PHI) Predicts High-stage Pathology in African American Men.
abstract: OBJECTIVE
  To evaluate the association between the Prostate Health Index (PHI) and adverse pathology in a cohort of African American (AA) men undergoing radical prostatectomy.
  
  
  METHODS
  Eighty AA men with prostate-specific antigen (PSA) of 2-10 ng/mL underwent measurement of PSA, free PSA (fPSA), and p2PSA prior to radical prostatectomy. PHI was calculated as [(p2PSA/fPSA) × (PSA)(½)]. Biomarker association with pT3 disease was assessed using logistic regression, and covariates were added to a baseline multivariable model including digital rectal examination. Biomarker ability to predict pT3 disease was measured using the area under the receiver operator characteristic curve.
  
  
  RESULTS
  Sixteen men (20%) demonstrated pT3 disease on final pathology. Mean age, PSA, and %fPSA were similar in men with and without pT3 disease (all P  >  .05), whereas PHI was significantly greater in men with pT3 disease (mean 57.2 vs 46.6, P  =  .04). Addition of PHI to the baseline multivariable model improved discriminative ability by 12.9% (P  =. .04) and yielded greater diagnostic accuracy than models, including other individual biomarkers.
  
  
  CONCLUSIONS
  In AA men with PSA of 2-10 ng/mL, PHI was predictive of pT3 prostate cancer and may help to identify men at increased risk of adverse pathology. Additional studies are needed to substantiate these findings and identify appropriate thresholds for clinical use.
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD. Electronic address: zschwen1@jhmi.edu.
authors.forename: Zeyad R
authors.initials: ZR
authors.lastname: Schwen
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Tosoian
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD; The Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Sokoll
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Leslie
authors.initials: L
authors.lastname: Mangold
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Humphreys
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD; The Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Schaeffer
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Alan W
authors.initials: AW
authors.lastname: Partin
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD; The Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Ross
mesh_terms: D001741:Black or African American; D015415:Biomarkers / Q000097:blood; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D017430:Prostate-Specific Antigen