PURPOSE: We performed a head-to-head comparison of Prostate Health Index (PHI) and Prostate Cancer Antigen 3 (PCA3).
METHODS: The performance of PHI and PCA3 were evaluated in 211 patients undergoing first (n=116) or repeat prostate biopsy (PBx) (n=95). Multivariable logistic regression analyses tested the accuracy (AUC) of PHI and PCA3 in predicting PCa in the overall population and in both settings. Decision curve analyses (DCA) were used to compare the clinical benefit of different models.
RESULTS: Overall, the AUC value of PHI (0.70) was significantly higher relative to those of PCA3 (0.59) (p=0.043), tPSA (0.56) (p=0.002) and %fPSA (0.60) (p=0.037). PHI was more accurate than PCA3 in predicting PCa in the initial setting (AUC: 0.69 vs. 0.57) and in the repeat setting (AUC: 0.72 vs. 0.63), even if no statistically significant difference was observed. The inclusion of PCA3 to the base multivariable model (BMM: PSA + %fPSA + prostate volume) did not increase the predictive accuracy in both settings (AUC:0.79 vs. 0.80 and 0.75 vs.0.76, respectively). Conversely, the inclusion of PHI to BMM improved the predictive accuracy by a 5% (AUC:0.79 to 0.84) and a 6% extent (AUC:0.75 to 0.81) in the initial and repeat PBx settings, respectively. At DCA, the highest net-benefit was observed when PHI was added to BMM.
CONCLUSIONS: Both PHI and PCA3 offer a significant increase in sensitivity and specificity compared to all other examined markers and may help to guide biopsy decisions. PCA3 does not increase the accuracy in predicting the presence of PCa when PHI is assessed.
Written by:
Scattoni V, Lazzeri M, Lughezzani G, De Luca S, Passera R, Bollito E, Randone D, Abdollah F, Capitanio U, Larcher A, Lista G, Gadda GM, Bini V, Montorsi F, Guazzoni G. Are you the author?
Department of Urology - University Vita-Salute, Scientific Institute H San Raffaele, Milan, Italy.
Reference: J Urol. 2013 Mar 1. pii: S0022-5347(13)03460-5.
doi: 10.1016/j.juro.2013.02.3184
PubMed Abstract
PMID: 23466239
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