The combination of prostate health index and multiparametric magnetic resonance imaging in prostate cancer diagnosis: efficacy analysis in different PSA ranges and its clinical decision-guiding value.

purposeThis study aims to investigate the diagnostic accuracy of prostate health index (PHI) in combination with multi-parametric magnetic resonance imaging (mpMRI) for the detection of prostate cancer (PCa). Furthermore, the study also seeks to evaluate the diagnostic performance of this combined approach across various PSA levels, with the goal of developing a personalized biopsy protocol.

methodsThis retrospective study enrolled 120 patients who underwent PSA, PHI, and mpMRI tests prior to prostate biopsy and were divided into the PCa group and the benign prostatic hyperplasia (BPH) group. Patients with ISUP >2 were classified as clinically significant prostate cancer (csPCa). MpMRI images were interpreted according to the Prostate Imaging Reporting and Data System, version 2. Diagnostic accuracy of each indicator was assessed using receiver operating characteristic (ROC) curve analysis. Independent predictors were identified through univariate and multivariate logistic regression analyses. Furthermore, the diagnostic performance of PHI, mpMRI, and their combination was evaluated.

resultsBased on the pathological biopsy results, 48 (40%) were diagnosed with PCa, while 72 (60%) patients had a benign lesion. The area under the curve (AUC) of PHI and PI-RADS score for PCa diagnosis was 0.747 and 0.790, respectively, both significantly higher than that of PSA (0.645) (p < 0.05). When PHI and PI-RADS score were used in combination, the sensitivity and specificity for PCa diagnosis were 81.3% and 68.1%, respectively.. Compared to the use of PSA, PHI or PI-RADS score alone, the specificity is enhanced while maintaining comparable sensitivity, potentially avoiding 50 (69.4%) cases of negative biopsies. Subgroup analysis stratified by PSA level showed that: (1) In the PSA ≤ 10 ng/ml subgroup, the AUC of PHI, PI-RADS score and PSA for PCa diagnosis was 0.698, 0.753 and 0.587 respectively, (p < 0.05). When the PHI and PI-RADS score are used in combination, the diagnostic sensitivity and specificity are 75.0% and 71.2%, respectively, which are superior than those of using either indicator alone; (2) In the PSA>10 ng/ml subgroup, PHI did not provide additional diagnostic benefits when used combined with PI-RADS score, with a diagnostic sensitivity of 65.0% and specificity of 90.0%. Correlation analysis of clinical indicators revealed that PHI was significantly correlated with PI-RADS score, Gleason score, and the number of positive biopsy cores.

conclusionsThis study demonstrates that PHI outperforms PSA in detecting PCa, with elevated PHI levels correlating with more advanced disease. Furthermore, combining PHI with mpMRI significantly enhances the detection rate of PCa, particularly among patients with low PSA levels.