Nomogram Using Prostate Health Index for Predicting Prostate Cancer in the Gray Zone: Prospective, Multicenter Study

Overview

Journal World J Mens Health

Date 2023 Apr 29

PMID 37118959

Authors

Jae Hoon Chung

Jeong Hyun Kim

Sang Wook Lee

Hongzoo Park

Geehyun Song

Wan Song

Minyong Kang

Hyun Hwan Sung

Hwang Gyun Jeon

Byong Chang Jeong

Seong Il Seo

Hyun Moo Lee

Seong Soo Jeon

Affiliations

Soon will be listed here.

Abstract

Purpose: To create a nomogram that can predict the probability of prostate cancer using prostate health index (PHI) and clinical parameters of patients. And the optimal cut-off value of PHI for prostate cancer was also assessed.

Materials And Methods: A prospective, multi-center study was conducted. PHI was evaluated prior to biopsy in patients requiring prostate biopsy due to high prostate-specific antigen (PSA). Among screened 1,010 patients, 626 patients with clinically suspected prostate cancer with aged 40 to 85 years, and with PSA levels ranging from 2.5 to 10 ng/mL were analyzed.

Results: Among 626 patients, 38.82% (243/626) and 22.52% (141/626) were diagnosed with prostate cancer and clinically significant prostate cancer, respectively. In the PSA 2.5 to 4 ng/mL group, the areas under the curve (AUCs) of the nomograms for overall prostate cancer and clinically significant prostate cancer were 0.796 (0.727-0.866; p<0.001), and 0.697 (0.598-0.795; p=0.001), respectively. In the PSA 4 to 10 ng/mL group, the AUCs of nomograms for overall prostate cancer and clinically significant prostate cancer were 0.812 (0.783-0.842; p<0.001), and 0.839 (0.810-0.869; p<0.001), respectively.

Conclusions: Even though external validations are necessary, a nomogram using PHI might improve the prediction of prostate cancer, reducing the need for prostate biopsies.

Citing Articles

Development and validation of biopsy free nomograms for predicting clinically significant prostate cancer in men with PI-RADS 4 and 5 lesions.

Wang J, Chen M, Guo S, Xu Y, Liu L, Jiang X Sci Rep. 2025; 15(1):2506.

PMID: 39833430 PMC: 11747484. DOI: 10.1038/s41598-025-86607-6.

References

Eastham J, May R, Robertson J, Sartor O, Kattan M . Development of a nomogram that predicts the probability of a positive prostate biopsy in men with an abnormal digital rectal examination and a prostate-specific antigen between 0 and 4 ng/mL. Urology. 1999; 54(4):709-13. DOI: 10.1016/s0090-4295(99)00213-7. View

Cooperberg M, Broering J, Kantoff P, Carroll P . Contemporary trends in low risk prostate cancer: risk assessment and treatment. J Urol. 2007; 178(3 Pt 2):S14-9. PMC: 2987559. DOI: 10.1016/j.juro.2007.03.135. View

Hori S, Blanchet J, McLoughlin J . From prostate-specific antigen (PSA) to precursor PSA (proPSA) isoforms: a review of the emerging role of proPSAs in the detection and management of early prostate cancer. BJU Int. 2012; 112(6):717-28. DOI: 10.1111/j.1464-410X.2012.11329.x. View

Mikolajczyk S, Millar L, Wang T, Rittenhouse H, Marks L, Song W . A precursor form of prostate-specific antigen is more highly elevated in prostate cancer compared with benign transition zone prostate tissue. Cancer Res. 2000; 60(3):756-9. View

Catalona W, Partin A, Sanda M, Wei J, Klee G, Bangma C . A multicenter study of [-2]pro-prostate specific antigen combined with prostate specific antigen and free prostate specific antigen for prostate cancer detection in the 2.0 to 10.0 ng/ml prostate specific antigen range. J Urol. 2011; 185(5):1650-5. PMC: 3140702. DOI: 10.1016/j.juro.2010.12.032. View

Zhu Y, Han C, Zhang G, Liu F, Ding Q, Xu J . Development and external validation of a prostate health index-based nomogram for predicting prostate cancer. Sci Rep. 2015; 5:15341. PMC: 4607975. DOI: 10.1038/srep15341. View

Stephan C, Vincendeau S, Houlgatte A, Cammann H, Jung K, Semjonow A . Multicenter evaluation of [-2]proprostate-specific antigen and the prostate health index for detecting prostate cancer. Clin Chem. 2012; 59(1):306-14. DOI: 10.1373/clinchem.2012.195784. View

Guazzoni G, Nava L, Lazzeri M, Scattoni V, Lughezzani G, Maccagnano C . Prostate-specific antigen (PSA) isoform p2PSA significantly improves the prediction of prostate cancer at initial extended prostate biopsies in patients with total PSA between 2.0 and 10 ng/ml: results of a prospective study in a clinical setting. Eur Urol. 2011; 60(2):214-22. DOI: 10.1016/j.eururo.2011.03.052. View

Lilja H, Christensson A, Dahlen U, Matikainen M, Nilsson O, Pettersson K . Prostate-specific antigen in serum occurs predominantly in complex with alpha 1-antichymotrypsin. Clin Chem. 1991; 37(9):1618-25. View

10.

van den Bergh R, Albertsen P, Bangma C, Freedland S, Graefen M, Vickers A . Timing of curative treatment for prostate cancer: a systematic review. Eur Urol. 2013; 64(2):204-15. PMC: 3784981. DOI: 10.1016/j.eururo.2013.02.024. View

11.

Jansen F, van Schaik R, Kurstjens J, Horninger W, Klocker H, Bektic J . Prostate-specific antigen (PSA) isoform p2PSA in combination with total PSA and free PSA improves diagnostic accuracy in prostate cancer detection. Eur Urol. 2010; 57(6):921-7. DOI: 10.1016/j.eururo.2010.02.003. View

12.

Lazzeri M, Haese A, Abrate A, De La Taille A, Palou Redorta J, McNicholas T . Clinical performance of serum prostate-specific antigen isoform [-2]proPSA (p2PSA) and its derivatives, %p2PSA and the prostate health index (PHI), in men with a family history of prostate cancer: results from a multicentre European study, the.... BJU Int. 2013; 112(3):313-21. DOI: 10.1111/bju.12217. View

13.

Thompson I, Ankerst D, Chi C, Goodman P, Tangen C, Lucia M . Assessing prostate cancer risk: results from the Prostate Cancer Prevention Trial. J Natl Cancer Inst. 2006; 98(8):529-34. DOI: 10.1093/jnci/djj131. View

14.

Schroder F, Hugosson J, Roobol M, Tammela T, Ciatto S, Nelen V . Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009; 360(13):1320-8. DOI: 10.1056/NEJMoa0810084. View

15.

Yu G, Na R, Ye D, Qi J, Liu F, Chen H . Performance of the Prostate Health Index in predicting prostate biopsy outcomes among men with a negative digital rectal examination and transrectal ultrasonography. Asian J Androl. 2016; 18(4):633-8. PMC: 4955192. DOI: 10.4103/1008-682X.172823. View

16.

Sathianathen N, Omer A, Harriss E, Davies L, Kasivisvanathan V, Punwani S . Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in the Detection of Clinically Significant Prostate Cancer in the Prostate Imaging Reporting and Data System Era: A Systematic Review and Meta-analysis. Eur Urol. 2020; 78(3):402-414. DOI: 10.1016/j.eururo.2020.03.048. View

17.

Le B, Griffin C, Loeb S, Carvalhal G, Kan D, Baumann N . [-2]Proenzyme prostate specific antigen is more accurate than total and free prostate specific antigen in differentiating prostate cancer from benign disease in a prospective prostate cancer screening study. J Urol. 2010; 183(4):1355-9. PMC: 3537165. DOI: 10.1016/j.juro.2009.12.056. View

18.

Draisma G, Etzioni R, Tsodikov A, Mariotto A, Wever E, Gulati R . Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context. J Natl Cancer Inst. 2009; 101(6):374-83. PMC: 2720697. DOI: 10.1093/jnci/djp001. View

19.

Chiu P, Ng C, Semjonow A, Zhu Y, Vincendeau S, Houlgatte A . A Multicentre Evaluation of the Role of the Prostate Health Index (PHI) in Regions with Differing Prevalence of Prostate Cancer: Adjustment of PHI Reference Ranges is Needed for European and Asian Settings. Eur Urol. 2018; 75(4):558-561. DOI: 10.1016/j.eururo.2018.10.047. View

20.

Chiu S, Cheng Y, Pu Y, Lu Y, Hong J, Chung S . Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection. Front Oncol. 2021; 11:772182. PMC: 8640459. DOI: 10.3389/fonc.2021.772182. View