Utilization of Prostate Health Index in prediction of prostate cancer aggressiveness

Authors: P. Brož 1,4;  O. Dolejšová 2;  R. Fuchsová 1;  O. Topolčan 1;  J. Racek 4;  H. Sedláčková 2;  O. Hes 3;  V. Eret 2;  L. Pecen 1;  M. Hora 2;  R. Kučera 1
Authors‘ workplace: Oddělení imunochemické diagnostiky FN a LF v Plzni, Univerzita Karlova v Praze 1;  Urologická klinika FN Plzeň 2;  Šiklův ústav patologie FN a LF v Plzni, Univerzita Karlova v Praze 3;  Ústav klinické biochemie a hematologie FN a LF v Plzni, Univerzita Karlova v Praze 4
Published in: Klin. Biochem. Metab., 27, 2019, No. 1, p. 9-15


Aim: To assess the Prostate Health Index (PHI) as a marker of tumor aggressiveness in comparison with prostate biopsy and postoperative histology.

Methods: Our cohort consisted of 474 patients indicated for radical prostatectomy with preoperative measurements of total prostate-specific antigen, free prostate-specific antigen, [-2]proPSA, calculated %freePSA, and PHI. The Gleason score was determined during biopsy and after radical prostatectomy. Using the Gleason score, we divided the group of patients into the 2 subgroups: Gleason score 6 and Gleason score ≥7. This division was performed according to the biopsy Gleason score and according to the postoperative Gleason score. We compared total prostate specific antigen, [-2]proPSA, %freePSA, and PHI in the subgroups Gleason score 6 and Gleason score ≥7 after biopsy and the definitive score.

Results: Of the calculated biopsy, Gleason score 6 and Gleason score ≥7 subgroups, [-2]proPSA, PHI and PSA (p < 0.0001, p < 0.0001 and p = 0.0012) were statistically significant. In case of %freePSA statistically significant differences were not present (p = 0.9306). Of the definitive Gleason score 6 and Gleason score ≥7 subgroups, PHI, [-2]proPSA, %freePSA, and PSA (p < 0.0001, p < 0.0001, p < 0.0001, and p = 0.0012) were statistically significant. The best area under the curve value (0.7649) was achieved by PHI when the subgroups were established according to the postoperative Gleason score.

Conclusion: PHI is the best of tested markers for the categorization of Gleason score 6 and Gleason score ≥7 tumors. Implementation of PHI can be useful in the management of patients with prostate cancer. PHI can be a helpful marker for indication of active surveillance or radical prostatectomy, or simplify the decision of whether to perform nerve-sparing radical prostatectomy.


Prostate Health Index – prostate-specific antigen – prostate cancer – Gleason score – prostate biopsy – radical prostatectomy


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