Abstract：
BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) followed by MRI-targeted prostate biopsy is the current standard for diagnosing prostate cancer (PCa). However, studies evaluating the value of biomarkers, including prostate health index (PHI) and its derivatives using this method are limited. We aimed to investigate the efficacy of PHI density (PHID) in guiding MRI-targeted prostate biopsies to identify clinically significant PCas (csPCa).
METHODS: The multicenter prospectively registered prostate biopsy database from three medical centers in Taiwan included patients with PHI and MRI-targeted and/or systematic prostate biopsies. We assessed the required values of prostate-specific antigen (PSA), prostate volume, PHI, PHID, and Prostate Imaging Reporting & Data System (PI-RADS) score using multivariable analyses, receiver operating characteristic curve analysis, and decision curve analyses (DCA). csPCa was defined as the International Society of Urological Pathology Gleason group ≥2 PCa, with an emphasis on reducing unwarranted biopsies.
RESULTS: The study cohort comprised 420 individuals. Diagnoses of PCa and csPCa were confirmed in 62.4% and 47.9% of the participants, respectively. The csPCa diagnosis rates were increased with increasing PI-RADS scores (20.5%, 44.2%, and 73.1% for scores 3, 4, and 5, respectively). Independent predictors for csPCa detection included PHI, prostate volume, and PI-RADS scores of 4 and 5 in multivariable analyses. The area under the curve (AUC) for csPCa of PHID (0.815) or PHI (0.788) was superior to that of PSA density (0.746) and PSA (0.635) in the entire cohort, and the superiority of PHID (0.758) was observed in PI-RADS 3 lesions. DCA revealed that PHID achieved the best net clinical benefit in PI-RADS 3-5 and 4/5 cases. Among PI-RADS 3 lesions, cutoff values of PHID 0.70 and 0.43 could eliminate 51.8% and 30.4% of omitted biopsies, respectively.
CONCLUSIONS: PHI-derived biomarkers, including PHID, performed better than other PSA-derived biomarkers in diagnosing PCa in MRI-detected lesions.
METHODS: The multicenter prospectively registered prostate biopsy database from three medical centers in Taiwan included patients with PHI and MRI-targeted and/or systematic prostate biopsies. We assessed the required values of prostate-specific antigen (PSA), prostate volume, PHI, PHID, and Prostate Imaging Reporting & Data System (PI-RADS) score using multivariable analyses, receiver operating characteristic curve analysis, and decision curve analyses (DCA). csPCa was defined as the International Society of Urological Pathology Gleason group ≥2 PCa, with an emphasis on reducing unwarranted biopsies.
RESULTS: The study cohort comprised 420 individuals. Diagnoses of PCa and csPCa were confirmed in 62.4% and 47.9% of the participants, respectively. The csPCa diagnosis rates were increased with increasing PI-RADS scores (20.5%, 44.2%, and 73.1% for scores 3, 4, and 5, respectively). Independent predictors for csPCa detection included PHI, prostate volume, and PI-RADS scores of 4 and 5 in multivariable analyses. The area under the curve (AUC) for csPCa of PHID (0.815) or PHI (0.788) was superior to that of PSA density (0.746) and PSA (0.635) in the entire cohort, and the superiority of PHID (0.758) was observed in PI-RADS 3 lesions. DCA revealed that PHID achieved the best net clinical benefit in PI-RADS 3-5 and 4/5 cases. Among PI-RADS 3 lesions, cutoff values of PHID 0.70 and 0.43 could eliminate 51.8% and 30.4% of omitted biopsies, respectively.
CONCLUSIONS: PHI-derived biomarkers, including PHID, performed better than other PSA-derived biomarkers in diagnosing PCa in MRI-detected lesions.
摘要：
背景：多参数磁共振成像（mpMRI）后再进行MRI靶向前列腺活检是目前诊断前列腺癌（PCa）的标准。然而,评估生物标志物价值的研究，包括前列腺健康指数(PHI)及其衍生物使用该方法是有限的。我们旨在研究PHI密度（PHID）在指导MRI靶向前列腺活检以识别临床上有意义的前列腺癌（csPCa）中的功效。
方法：来自台湾三个医疗中心的多中心前瞻性登记前列腺活检数据库包括PHI和MRI靶向和/或系统性前列腺活检的患者。我们评估了前列腺特异性抗原（PSA）的要求值，前列腺体积,PHI,PHID,和前列腺成像报告和数据系统（PI-RADS）评分使用多变量分析，接收机工作特性曲线分析，和决策曲线分析(DCA)。CSPCa被定义为国际泌尿外科病理学学会Gleason组≥2PCa，重点是减少不必要的活检。
结果：研究队列包括420名个体。在62.4％和47.9％的参与者中确认了PCa和csPCa的诊断，分别。CSPCa诊断率随PI-RADS评分的增加而增加(20.5%,44.2%,得分3、4和5分别为73.1%)。CSPCa检测的独立预测因子包括PHI，前列腺体积,在多变量分析中，PI-RADS评分分别为4和5分。在整个队列中，PHID（0.815）或PHI（0.788）的csPCa的曲线下面积（AUC）优于PSA密度（0.746）和PSA（0.635），在PI-RADS3个病变中观察到PHID（0.758）的优越性。DCA显示，PHID在PI-RADS3-5和4/5例中取得了最佳的净临床效益。在PI-RADS3个病变中，PHID0.70和0.43的截止值可以消除51.8%和30.4%的遗漏活检，分别。
结论：PHI衍生的生物标志物，包括PHID,在MRI检测到的病变中诊断PCa方面，比其他PSA衍生的生物标志物表现更好。
方法：来自台湾三个医疗中心的多中心前瞻性登记前列腺活检数据库包括PHI和MRI靶向和/或系统性前列腺活检的患者。我们评估了前列腺特异性抗原（PSA）的要求值，前列腺体积,PHI,PHID,和前列腺成像报告和数据系统（PI-RADS）评分使用多变量分析，接收机工作特性曲线分析，和决策曲线分析(DCA)。CSPCa被定义为国际泌尿外科病理学学会Gleason组≥2PCa，重点是减少不必要的活检。
结果：研究队列包括420名个体。在62.4％和47.9％的参与者中确认了PCa和csPCa的诊断，分别。CSPCa诊断率随PI-RADS评分的增加而增加(20.5%,44.2%,得分3、4和5分别为73.1%)。CSPCa检测的独立预测因子包括PHI，前列腺体积,在多变量分析中，PI-RADS评分分别为4和5分。在整个队列中，PHID（0.815）或PHI（0.788）的csPCa的曲线下面积（AUC）优于PSA密度（0.746）和PSA（0.635），在PI-RADS3个病变中观察到PHID（0.758）的优越性。DCA显示，PHID在PI-RADS3-5和4/5例中取得了最佳的净临床效益。在PI-RADS3个病变中，PHID0.70和0.43的截止值可以消除51.8%和30.4%的遗漏活检，分别。
结论：PHI衍生的生物标志物，包括PHID,在MRI检测到的病变中诊断PCa方面，比其他PSA衍生的生物标志物表现更好。
