Abstract

OBJECTIVE: We assessed whether Prostate Health Index (phi) results improve prediction of grade reclassification for men on active surveillance.METHODS/MATERIALS: We identified men in Canary Prostate Active Surveillance Study with Grade Group (GG) 1 cancer. Outcome was grade reclassification to GG2+ cancer. We considered decision rules to maximize specificity with sensitivity set at 95%. We derived rules based on clinical data (R1) vs clinical data+phi (R3). We considered an "or"-logic rule combining clinical score and phi (R4), and a "two-step" rule using clinical data followed by risk stratification based on phi (R2). Rules were applied to a validation set, where values of R2 - R4 vs R1 for specificity and sensitivity were evaluated.RESULTS: We included 1532 biopsies (n=610 discovery; n=922 validation) among 1142 men. Grade reclassification was seen in 27% of biopsies (23% discovery, 29% validation). Among discovery set, at 95% sensitivity, R2 yielded highest specificity at 27% vs 17% for R1. In validation set, R3 had best performance vs R1 with Deltasensitivity = -4% and Deltaspecificity = +6%. There was slight improvement for R3 vs R1 for confirmatory biopsy (AUC 0.745 vs R1 0.724, DeltaAUC=0.021, 95%CI 0.002-0.041) but not for subsequent biopsies (DeltaAUC=-0.012, 95%CI -0.031-0.006). R3 did not have better discrimination vs R1 among the biopsy cohort overall (DeltaAUC=0.007, 95%CI -0.007-0.020).CONCLUSIONS: Among active surveillance patients, using phi with clinical data modestly improved prediction of grade reclassification on confirmatory biopsy and did not improve prediction on subsequent biopsies.

View details for DOI 10.1097/JU.0000000000002852

View details for PubMedID 35830553