title: The Prostate Health Index adds predictive value to multi-parametric MRI in detecting significant prostate cancers in a repeat biopsy population.
abstract: Both multi-parametric MRI (mpMRI) and the Prostate Health Index (PHI) have shown promise in predicting a positive biopsy in men with suspected prostate cancer. Here we investigated the value of combining both tests in men requiring a repeat biopsy. PHI scores were measured in men undergoing re-biopsy with an mpMRI image-guided transperineal approach (n = 279, 94 with negative mpMRIs). The PHI was assessed for ability to add value to mpMRI in predicting all or only significant cancers (Gleason ≥7). In this study adding PHI to mpMRI improved overall and significant cancer prediction (AUC 0.71 and 0.75) compared to mpMRI + PSA alone (AUC 0.64 and 0.69 respectively). At a threshold of ≥35, PHI + mpMRI demonstrated a NPV of 0.97 for excluding significant tumours. In mpMRI negative men, the PHI again improved prediction of significant cancers; AUC 0.76 vs 0.63 (mpMRI + PSA). Using a PHI≥35, only 1/21 significant cancers was missed and 31/73 (42%) men potentially spared a re-biopsy (NPV of 0.97, sensitivity 0.95). Decision curve analysis demonstrated clinically relevant utility of the PHI across threshold probabilities of 5-30%. In summary, the PHI adds predictive performance to image-guided detection of clinically significant cancers and has particular value in determining re-biopsy need in men with a negative mpMRI.
authors.affiliation: Academic Urology Group, University of Cambridge, Box 279 (S4) Cambridge Biomedical Campus Cambridge CB2 0QQ, UK.|CamPARI Clinic, Box 41, Clinic 4A, Cambridge University Hospitals Trust, Cambridge CB2 0QQ UK.|Department of Urology, Cambridge University Hospitals Trust, Cambridge CB2 0QQ UK.
authors.forename: V J
authors.initials: VJ
authors.lastname: Gnanapragasam
authors.affiliation: Core Biochemical Assay Laboratory, Cambridge University Hospitals Trust, Cambridge CB2 0QQ UK.
authors.forename: K
authors.initials: K
authors.lastname: Burling
authors.affiliation: Academic Urology Group, University of Cambridge, Box 279 (S4) Cambridge Biomedical Campus Cambridge CB2 0QQ, UK.
authors.forename: A
authors.initials: A
authors.lastname: George
authors.affiliation: Academic Urology Group, University of Cambridge, Box 279 (S4) Cambridge Biomedical Campus Cambridge CB2 0QQ, UK.
authors.forename: S
authors.initials: S
authors.lastname: Stearn
authors.affiliation: Department of Pathology, Cambridge University Hospitals Trust,Cambridge CB2 0QQ UK.
authors.forename: A
authors.initials: A
authors.lastname: Warren
authors.affiliation: Department of Radiology, University of Cambridge, Cambridge CB2 0QQ UK.|Department of Radiology, Cambridge University Hospitals Trust, Cambridge CB2 0QQ UK.
authors.forename: T
authors.initials: T
authors.lastname: Barrett
authors.affiliation: Department of Radiology, University of Cambridge, Cambridge CB2 0QQ UK.
authors.forename: B
authors.initials: B
authors.lastname: Koo
authors.affiliation: Department of Radiology, University of Cambridge, Cambridge CB2 0QQ UK.|Department of Radiology, Cambridge University Hospitals Trust, Cambridge CB2 0QQ UK.
authors.forename: F A
authors.initials: FA
authors.lastname: Gallagher
authors.affiliation: CamPARI Clinic, Box 41, Clinic 4A, Cambridge University Hospitals Trust, Cambridge CB2 0QQ UK.|Department of Urology, Cambridge University Hospitals Trust, Cambridge CB2 0QQ UK.
authors.forename: A
authors.initials: A
authors.lastname: Doble
authors.affiliation: CamPARI Clinic, Box 41, Clinic 4A, Cambridge University Hospitals Trust, Cambridge CB2 0QQ UK.|Department of Urology, Cambridge University Hospitals Trust, Cambridge CB2 0QQ UK.
authors.forename: C
authors.initials: C
authors.lastname: Kastner
authors.affiliation: Edinburgh Clinical Trials Unit University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh EH89AG UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Parker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D014408:Biomarkers, Tumor / Q000378:metabolism; D001706:Biopsy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000503:physiopathology*; D015203:Reproducibility of Results
chemical_list: D014408:Biomarkers, Tumor