The Prostate Health Index adds predictive value to multi-parametric MRI in detecting significant prostate cancers in a repeat biopsy population
The Prostate Health Index adds predictive value to multi-parametric MRI in detecting significant prostate cancers in a repeat biopsy population
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DOI：
10.1038/srep35364
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发表时间：
2016-10-17
影响因子：
4.6
通讯作者：
Parker, R. A.
中科院分区：
文献类型：
--
作者：
Gnanapragasam, V. J.;Burling, K.;Parker, R. A.
多参数 MRI (mpMRI) 和前列腺健康指数 (PHI) 都有望预测疑似前列腺癌男性的活检结果呈阳性。在这里，我们研究了将两种测试结合起来对需要重复活检的男性的价值。 PHI 评分是在接受 mpMRI 图像引导经会阴入路再次活检的男性中测量的（n = 279，其中 94 例 mpMRI 呈阴性）。评估 PHI 在预测所有或仅显着癌症 (Gleason >= 7) 方面为 mpMRI 增加价值的能力。在这项研究中，与单独使用 mpMRI + PSA（AUC 分别为 0.64 和 0.69）相比，在 mpMRI 中添加 PHI 改善了总体和显着的癌症预测（AUC 0.71 和 0.75）。在阈值 >= 35 时，PHI + mpMRI 显示排除显着肿瘤的 NPV 为 0.97。在 mpMRI 阴性男性中，PHI 再次提高了对重大癌症的预测； AUC 0.76 与 0.63（mpMRI + PSA）。使用 PHI >= 35，只有 1/21 的显着癌症被遗漏，31/73 (42%) 的男性可能免于再次活检（NPV 为 0.97，敏感性 0.95）。决策曲线分析证明了 PHI 在 5-30% 阈值概率范围内的临床相关效用。总之，PHI 为临床显着癌症的图像引导检测增加了预测性能，并且在确定 mpMRI 阴性男性的重新活检需求方面具有特殊价值。
Both multi-parametric MRI (mpMRI) and the Prostate Health Index (PHI) have shown promise in predicting a positive biopsy in men with suspected prostate cancer. Here we investigated the value of combining both tests in men requiring a repeat biopsy. PHI scores were measured in men undergoing re-biopsy with an mpMRI image-guided transperineal approach (n = 279, 94 with negative mpMRIs). The PHI was assessed for ability to add value to mpMRI in predicting all or only significant cancers (Gleason >= 7). In this study adding PHI to mpMRI improved overall and significant cancer prediction (AUC 0.71 and 0.75) compared to mpMRI + PSA alone (AUC 0.64 and 0.69 respectively). At a threshold of >= 35, PHI + mpMRI demonstrated a NPV of 0.97 for excluding significant tumours. In mpMRI negative men, the PHI again improved prediction of significant cancers; AUC 0.76 vs 0.63 (mpMRI + PSA). Using a PHI >= 35, only 1/21 significant cancers was missed and 31/73 (42%) men potentially spared a re-biopsy (NPV of 0.97, sensitivity 0.95). Decision curve analysis demonstrated clinically relevant utility of the PHI across threshold probabilities of 5-30%. In summary, the PHI adds predictive performance to image-guided detection of clinically significant cancers and has particular value in determining re-biopsy need in men with a negative mpMRI.