Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.
Urology Research Center, Fudan University, Shanghai 200040, China.
Asian J Androl. 2019 Nov-Dec;21(6):592-597. doi: 10.4103/aja.aja_125_18.
Risk prediction models including the Prostate Health Index (phi) for prostate cancer have been well established and evaluated in the Western population. The aim of this study is to build phi-based risk calculators in a prostate biopsy population and evaluate their performance in predicting prostate cancer (PCa) and high-grade PCa (Gleason score ≥7) in the Chinese population. We developed risk calculators based on 635 men who underwent initial prostate biopsy. Then, we validated the performance of prostate-specific antigen (PSA), phi, and the risk calculators in an additional observational cohort of 1045 men. We observed that the phi-based risk calculators (risk calculators 2 and 4) outperformed the PSA-based risk calculator for predicting PCa and high-grade PCa in the training cohort. In the validation study, the area under the receiver operating characteristic curve (AUC) for risk calculators 2 and 4 reached 0.91 and 0.92, respectively, for predicting PCa and high-grade PCa, respectively; the AUC values were better than those for risk calculator 1 (PSA-based model with an AUC of 0.81 and 0.82, respectively) (all P < 0.001). Such superiority was also observed in the stratified population with PSA ranging from 2.0 ng mlto 10.0 ng ml. Decision curves confirmed that a considerable proportion of unnecessary biopsies could be avoided while applying phi-based risk calculators. In this study, we showed that, compared to risk calculators without phi, phi-based risk calculators exhibited superior discrimination and calibration for PCa in the Chinese biopsy population. Applying these risk calculators also considerably reduced the number of unnecessary biopsies for PCa.
包括前列腺健康指数（phi）在内的前列腺癌风险预测模型已在西方人群中得到很好的建立和评估。本研究旨在建立基于 phi 的风险计算器，并在前列腺活检人群中评估其在预测中国人群前列腺癌（PCa）和高级别 PCa（Gleason 评分≥7）的性能。我们基于 635 名接受初始前列腺活检的男性开发了风险计算器。然后，我们在另外 1045 名男性的观察队列中验证了前列腺特异性抗原（PSA）、phi 和风险计算器的性能。我们观察到，在训练队列中，基于 phi 的风险计算器（风险计算器 2 和 4）在预测 PCa 和高级别 PCa 方面优于基于 PSA 的风险计算器。在验证研究中，风险计算器 2 和 4 预测 PCa 和高级别 PCa 的受试者工作特征曲线下面积（AUC）分别达到 0.91 和 0.92，优于风险计算器 1（基于 PSA 的模型 AUC 分别为 0.81 和 0.82）（均 P < 0.001）。在 PSA 范围在 2.0 ng/ml 至 10.0 ng/ml 的分层人群中也观察到了这种优势。决策曲线证实，在应用 phi 风险计算器时，可以避免相当一部分不必要的活检。在这项研究中，我们表明，与不包含 phi 的风险计算器相比，phi 风险计算器在我国前列腺活检人群中对 PCa 的鉴别和校准具有更好的效果。应用这些风险计算器还可以大大减少不必要的 PCa 活检数量。
