Department of Urology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Berlin Institute for Urologic Research, Berlin, Germany.
World J Urol. 2021 Sep;39(9):3273-3279. doi: 10.1007/s00345-020-03585-2. Epub 2021 Jan 20.
To evaluate the Prostate Health Index (PHI) density (PHID) in direct comparison with PHI in a prospective large cohort.
PHID values were calculated from prostate-specific antigen (PSA), free PSA and [- 2]proPSA and prostate volume. The 1057 patients included 552 men with prostate cancer (PCa) and 505 with no evidence of malignancy (NEM). In detail, 562 patients were biopsied at the Charité Hospital Berlin and 495 patients at the Sana Hospital Offenbach. All patients received systematic or magnetic resonance imaging (MRI)/ultrasound fusion-guided biopsies. The diagnostic accuracy was evaluated by receiver operating characteristic (ROC) curves comparing areas under the ROC-curves (AUC). The decision curve analysis (DCA) was performed with the MATLAB Neural Network Toolbox.
PHID provided a significant larger AUC than PHI (0.835 vs. 0.801; p = 0.0013) in our prospective cohort of 1057 men from 2 centers. The DCA had a maximum net benefit of ~ 5% for PHID vs. PHI between 35 and 65% threshold probability. In those 698 men within the WHO-calibrated PSA grey-zone up to 8 ng/ml, PHID was also significantly better than PHI (AUC 0.819 vs. 0.789; p = 0.0219). But PHID was not different from PHI in the detection of significant PCa.
Based on ROC analysis and DCA, PHID had an advantage in comparison with PHI alone to detect any PCa but PHI and PHID performed equal in detecting significant PCa.
在一个前瞻性大队列中，直接比较前列腺健康指数（PHI）密度（PHID）与 PHI。
通过前列腺特异性抗原（PSA）、游离 PSA 和 [-2]proPSA 以及前列腺体积计算 PHID 值。1057 例患者包括 552 例前列腺癌（PCa）患者和 505 例无恶性肿瘤证据（NEM）患者。详细信息，562 例患者在柏林 Charité 医院接受活检，495 例患者在奥芬巴赫 Sana 医院接受活检。所有患者均接受系统或磁共振成像（MRI）/超声融合引导活检。通过比较 ROC 曲线下面积（AUC）来评估诊断准确性。使用 MATLAB 神经网络工具箱进行决策曲线分析（DCA）。
PHID 比 PHI 在我们的 2 个中心的 1057 名男性前瞻性队列中提供了更大的 AUC（0.835 对 0.801；p=0.0013）。在 35%至 65%阈值概率之间，DCA 对 PHID 与 PHI 之间的净获益最大约为 5%。在那些达到 8ng/ml 的 WHO 校准 PSA 灰区的 698 名男性中，PHID 也明显优于 PHI（AUC 0.819 对 0.789；p=0.0219）。但 PHID 在检测显著 PCa 方面与 PHI 没有差异。
基于 ROC 分析和 DCA，与单独使用 PHI 相比，PHID 在检测任何 PCa 方面具有优势，但 PHI 和 PHID 在检测显著 PCa 方面表现相同。
