Use of the Prostate Health Index for detection of prostate cancer: results from a large academic practice

Background:the prostate health index (phi) outperforms psa and other psa derivatives for the diagnosis of prostate cancer (pca). the impact of phi testing in the real-world clinical setting has not been previously assessed.methods:in a single, large, academic center, phi was tested in 345 patients presenting for diagnostic evaluation for pca. findings on prostate biopsy (including grade group (gg), defined as gg1: gleason score (gs) 6, gg2: gs 3+4=7, gg3: gs 4+3=7, gg4: gs 8 and gg5: gs 9–10), magnetic resonance imaging (mri) and radical prostatectomy (rp) were prospectively recorded. biopsy rates and outcomes were compared with a contemporary cohort that did not undergo phi testing (n=1318).results:overall, 39% of men with phi testing underwent prostate biopsy. no men with phi<19.6 were diagnosed with pca, and only three men with phi<27 had cancer of gg⩾2. phi was superior to psa for the prediction of any pca (area under the receiver operating characteristic curve (auc) 0.72 vs 0.47) and gg⩾2 pca (auc 0.77 vs 0.53) on prostate biopsy. among men undergoing mri and phi, no men with phi<27 and pi-rads⩽3 had gg⩾2 cancer. for those men proceeding to rp, increasing phi was associated with higher pathologic gg (p=0.002) and stage (p=0.001). compared with patients who did not undergo phi testing, the use of phi was associated with a 9% reduction in the rate of prostate biopsy (39% vs 48%; p<0.001). importantly, the reduction in biopsy among the phi population was secondary to decreased incidence of negative (8%) and gg1 (1%) biopsies, whereas the proportion of biopsies detecting gg⩾2 cancers remained unchanged.conclusions:in this large, real-time clinical experience, phi outperformed psa alone, was associated with high-grade pca, and provided complementary information to mri. incorporation of phi into clinical practice reduced the rate of unnecessary biopsies without changing the frequency of detection of higher-grade cancers.